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**Kosiborod Mcirculation1687122448120mg/dL6.7mmol/L10mg/dL OR=1.8 P=0.003; 70 mg/dL3.9mmol/LOR=6.4 p=0.01JJOR3.9mmol/LGlucometrics in patients hospitalized with acute myocardial infarction: defining the optimal outcomes-based measure of risk.Kosiborod M, Inzucchi SE, Krumholz HM, Xiao L, Jones PG, Fiske S, Masoudi FA, Marso SP, Spertus JA.Mid America Heart Institute of Saint Luke's Hospital, 4401 Wornall Rd, Kansas City, MO 64111, USA. mkosiborod@cc-pc.comBACKGROUND: Hyperglycemia on admission is associated with an increased mortality rate in patients with acute myocardial infarction. Whether metrics that incorporate multiple glucose assessments during acute myocardial infarction hospitalization are better predictors of mortality than admission glucose alone is not well defined. METHODS AND RESULTS: We evaluated 16,871 acute myocardial infarction patients hospitalized from January 2000 to December 2005. Using logistic regression models and C indexes, 3 metrics of glucose control (mean glucose, time-averaged glucose, hyperglycemic index), each evaluated over 3 time windows (first 24 hours, 48 hours, entire hospitalization), were compared with admission glucose for their ability to discriminate hospitalization survivors from nonsurvivors. Models were then used to evaluate the relationship between mean glucose and in-hospital mortality. All average glucose metrics performed better than admission glucose. The ability of models to predict mortality improved as the time window increased (C indexes for admission, mean 24 hours, 48 hours, and hospitalization glucose were 0.62, 0.64, 0.66, 0.70; P or = 120 mg/dL (odds ratio, 1.8; P=0.003 for glucose 120 to < 130 mg/dL) and with incremental decline < 70 mg/dL (odds ratio, 6.4; P=0.01 versus glucose 100 to < 110 mg/dL). The slope of these relationships was steeper in patients without diabetes. CONCLUSIONS: Measures of persistent hyperglycemia during acute myocardial infarction are better predictors of mortality than admission glucose. Mean hospitalization glucose appears to be the most practical metric of hyperglycemia-associated risk. A J-shaped relationship exists between average glucose and mortality, with both persistent hyperglycemia and hypoglycemia associated with adverse prognosis.**Desouza C21CAD2HOLTER21195410659p100 mg over a 60-min period, and ischemic symptoms occurred during 9 of these episodes (P < 0.01 compared with stable normoglycemia or hyperglycemia). CONCLUSIONS: Hypoglycemia is more likely to be associated with cardiac ischemia and symptoms than normoglycemia and hyperglycemia, and it is particularly common in patients who experience considerable swings in blood glucose. These data may be important in the institution of insulin treatment and attempting near-normal glycemia in patients with known CAD. Further research is needed to determine strategies to prevent ischemia associated with hypoglycemia.*FISMAN EZ81467045-75669 mg/dl13170-79 mg/dl73180-109 mg/dl9308IFG110-125 mg/dl1577126-139 mg/dl6178p or 140 mg/dl). RESULTS: Patients comprised 131 with hypoglycaemia (0.9%), 731 with low normal glucose (5%), 9308 euglycaemic (63.4%), 1577 with IFG (10.7%), 617 borderline diabetics (4.2%) and 2306 diabetics (15.7%). Over a mean 8-year follow-up, crude all-cause mortality was higher in both diabetic (31.8%) and hypoglycaemic groups (25.2%) as compared with euglycaemics (14.9%; P