Impact of glycemic state on hospital outcome in patients with acute coronary syndrome in sohag university hospitals

Document Type : Original Article

Authors

Department of Internal Medicine, Faculty of Medicine, Sohag University

Abstract


  
Background
 
 Hyperglycemia is common and related to more morbidity and death rates in hospitalized patients with acute coronary syndromes (ACS). We planned to research the relationship between the glycemic state and the hospital outcomes in ACS patients.
Methods
It was a prospective cohort study in included 150 patients admitted to the coronary care unit (CCU) with ACS at Sohag University hospital and were followed up for one month. We classified the patients into three gatherings regarding their glycemic state, group A (euglycemic), group B (hyperglycemia and not diabetic), and group C (hyperglycemia and known to be diabetic).
Results
 We found no significant difference in the individual hospital outcomes, including serious arrhythmia, acute pulmonary edema, cardiogenic shock, recurrent ischemia, heart failure, cerebrovascular stroke (CVS), or all-cause deaths in the three groups. There was a significantly higher total outcome in hyperglycemic patients (group B+ C) compared to euglycemic patients (group A) after multivariate regression analysis and confounders adjustment (Adjusted OR was 1.79; 95% CI 1.31-3.12; p-value 0.01).
Conclusion:In both diabetic and non-diabetic patients presented with ACS, the admission hyperglycemia has a harmful impact on the hospital outcomes. So, strict monitoring of the blood glucose levels at admission for all ACS patients is required, and tight management of hyperglycemia is mandatory.

Keywords

References

References
1. Kannel WB, McGee DL: Diabetes and cardiovascular disease: the Framingham study. JAMA, 2004. 241: 2035 – 2038.
2. Malmberg K, Rydén L, Wedel H, et al: DIGAMI 2 Investigators. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J. 2004; 26:650–661.
3. Capes SE, Hunt D, Malmberg K, et al: Stress hyperglycemia and increased risk for death after myocardial infarction in patients with and without diabetes: a systemic overview. Lancet, 2013, 355:773 –778.
4. Norhammar A, Tenerz A, Nilsson G, et al: Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: A prospective study. Lancet 2004; 359:2140.
5. Heine, R. J., & Dekker, J. M.: Beyond postprandial hyperglycaemia: metabolic factors associated with cardiovascular disease. Diabetologia, 2011; 45 (4), 461-475.
6. Foo K, Cooper J, Deaner A, et al: A single serum glucose measurements predicts adverse outcomes across the whole range of acute coronary syndromes. Heart 2003; 89: 512 – 16.
7. Standards of Medical Care in Diabetes. Diabetes Care 2015; 38 (Suppl 1): S3
8. Efrain Reisin, Raymond C. Harris, Mahboob Rahman. Commentary on the 2014 BP Guidelines from the Panel Appointed to the Eighth Joint National Committee (JNC 8). J Am Soc Nephrol. 2014 Nov; 25(11): 2419–2424.
9. Kenneth F. Arthur Schatzkin, Tamara B. Harris, et al. Overweight, Obesity, and Mortality in a Large Prospective Cohort of Persons 50 to 71 Years Old. N Engl J Med 2006; 355:763-778
10. Meier JJ, Deifuss S, Klamann A, et al: Plasma glucose at hospital admission and previous metabolic controldetermine myocardial infarct size and survival in patients with andwithout type 2 diabetes: the Langendreer Myocardial Infarction andBlood Glucose in Diabetic Patients Assessment (LAMBDA). Diabetes Care. 2005; 28:2551–2553.
11. Wahab NN, Cowden EA, Pearce NJ, et al: ICONS Investigators. Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era? J Am CollCardiol. 2002; 40:1748–1754.9.
12. Stranders, I., Diamant, M., Van Gelder, R., Spruijt, H., Twisk, J., Heine, R. Et al. Admission blood glucose level as risk indicator of death after myocardial infarction in patients with and without diabetes mellitus. Arch Intern Med 2004;164: 982–988
13. Mehta SR, Yusuf S, Diaz R, et al: CREATE-ECLA Trial Group. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: theCREATE-ECLA randomized controlled trial. JAMA. 2005;293:437–446.
14. Turner R C, Millns H, Neil H A, et al: Risk factors for coronary artery disease in non­insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS: 23).BMJ 1998; 316; 823-828.
15. Surekha R, Madhavi1 G, Ramachandra R, et al: risk factors for coronary heart disease in type ii diabetes mellitus. Indian Journal of Clinical Biochemistry, 2005, 20 (2) 75-80.
16. Damaris M, Dragana R, Edoardo C, et al: Admission glycaemia and outcome in patients with acute coronary syndrome. Diabetes and Vascular disease research, 2007, volume 4 issue 4. December.
17. Norhammar A, Tenerz A, Nilsson G,et al: Admission plasma glucose :independent risk factor for long-term prognosis after myocardial infarction even in nondiabetic patents. Diabetes Care, 1999,22 : 1827- 1831
Sohag Medical Journal
Volume 22, Issue 3
October 2018
Pages 117-124

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