BACKGROUND Hyperglycemia in the setting of an acute coronary syndrome (ACS) impacts short term outcomes, but little is known about longer term effects. We therefore designed this study to firstly determine the association between hyperglycemia and short term and longer term outcomes in patients presenting with ACS and secondly evaluate the prognostic role of diabetes, body mass index (BMI) and the novel biomarker Cyr61 on outcomes. METHODS The prospective Special Program University Medicine-Acute Coronary Syndrome (SPUM-ACS) cohort enrolled 2168 patients with ACS between December 2009 and October 2012, of which 2034 underwent PCI (93.8%). Patients were followed up for 12 months. Events were independently adjudicated by three experienced cardiologists. Participants were recruited from four tertiary hospitals in Switzerland: Zurich, Geneva, Lausanne and Bern. Participants presenting with acute coronary syndromes and who underwent coronary angiography were included in the analysis. Patients were grouped according to history of diabetes (or HbA1c greater than 6%), baseline blood sugar level (BSL; < 6, 6-11.1 and > 11.1 mmol/L) and body mass index (BMI). The primary outcome was major adverse cardiac events (MACE) which was a composite of myocardial infarction, stroke and all-cause death. Secondary outcomes included the individual components of the primary endpoint, revascularisations, bleeding events (BARC classification) and cerebrovascular events (ischaemic or haemorrhagic stroke or TIA). RESULTS Patients with hyperglycemia, i.e. BSL ≥ 11.1 mmol/L, had higher levels of C-reactive protein (CRP), white blood cell count (WBC), creatinine kinase (CK), higher heart rates and lower left ventricular ejection fraction (LVEF) and increased N-terminal pro-brain natriuretic peptide. At 30 days and 12 months, those with BSL ≥ 11.1 mmol/L had more MACE and death compared to those with BSL < 6.0 mmol/L or 6.0-11.1 mmol/L (HR-ratio 4.78 and 6.6; p < 0.001). The novel biomarker Cyr61 strongly associated with high BSL and STEMI and was independently associated with 1 year outcomes (HR 2.22; 95% CI 1.33-3.72; Tertile 3 vs. Tertile 1). CONCLUSIONS AND RELEVANCE In this large, prospective, independently adjudicated cohort of in all comers ACS patients undergoing PCI, both a history of diabetes and elevated entry glucose was associated with inflammation and increased risk of MACE both at short and long-term. The mediators might involve increased sympathetic activation, inflammation and ischemia as reflected by elevated Cyr61 levels leading to larger levels of troponin and lower LVEF. Trial registration Clinical Trial Registration Number: NCT01000701. Registered October 23, 2009.

中文翻译：

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糖尿病和基线血糖与急性冠状动脉综合征的炎症，左心室功能以及短期和长期预后有关：新型生物标志物Cyr 61的作用。

背景技术在急性冠状动脉综合征（ACS）的情况下，高血糖影响短期结果，但是对于长期作用知之甚少。因此，我们设计了这项研究，以首先确定患有ACS的患者的高血糖与短期和长期预后之间的关联，其次评估糖尿病，体重指数（BMI）和新的生物标志物Cyr61对预后的预​​后作用。方法在2009年12月至2012年10月之间，前瞻性特殊计划大学医学急性冠脉综合征（SPUM-ACS）队列招募了2168例ACS患者，其中2034例行PCI（93.8％）。对患者进行了12个月的随访。事件由三位经验丰富的心脏病专家独立裁决。参与者来自瑞士的四家三级医院：苏黎世，日内瓦，洛桑和伯尔尼。分析中包括表现出急性冠状动脉综合征并进行了冠状动脉造影的参与者。根据糖尿病史（或HbA1c大于6％），基线血糖水平（BSL； <6、6-11.1和> 11.1 mmol / L）和体重指数（BMI）对患者进行分组。主要结果是主要的不良心脏事件（MACE），这是心肌梗塞，中风和全因死亡的综合结果。次要结果包括主要终点的各个组成部分，血运重建，出血事件（BARC分类）和脑血管事件（缺血性或出血性中风或TIA）。结果高血糖（BSL≥11.1 mmol / L）患者的C反应蛋白（CRP），白细胞计数（WBC），肌酐激酶（CK），较高的心率和较低的左心室射血分数（LVEF）和N端前脑利钠肽的增加。在30天和12个月时，与BSL <6.0 mmol / L或6.0-11.1 mmol / L的那些相比，BSL≥11.1 mmol / L的那些具有更高的MACE和死亡（HR比率4.78和6.6； p <0.001）。新型生物标志物Cyr61与高BSL和STEMI密切相关，并独立与1年结局相关（HR 2.22； 95％CI 1.33-3.72； Tertile 3 vs. Tertile 1）。结论和相关性在所有接受PCI手术的ACS患者中，有大量前瞻性，独立研究的队列研究，既有糖尿病史又有高血糖进入，与炎症和短期和长期MACE风险增加有关。调解员可能涉及更多的交感神经激活，Cyr61水平升高导致肌钙蛋白水平升高和LVEF降低反映出炎症和缺血。试验注册临床试验注册号：NCT01000701。2009年10月23日注册。