THE STUDY OF STRESS HYPERGLYCEMIA AND DIABETES MELLITUS IN PROGNOSIS OF ACUTE CORONARY SYNDROME IN TERTIARY CARE HOSPITAL

RAMAVATH ABHINAV; VINOD KHANDAIT

doi:10.22159/ajpcr.2024v17i12.53463

Authors

RAMAVATH ABHINAV Department of General Medicine, Kamineni Hospitals, Hyderabad, Telangana, India
VINOD KHANDAIT Department of General medicine, Government Medical College, Nagpur, Maharashtra, India.

DOI:

https://doi.org/10.22159/ajpcr.2024v17i12.53463

Keywords:

Acute coronary syndrome, Stress hyperglycemia, Diabetes mellitus, Cardiogenic shock, Heart failure

Abstract

Objective: Acute coronary syndrome (ACS) is a leading cause of morbidity and mortality globally. Stress hyperglycemia and diabetes mellitus significantly influence outcomes in ACS patients. This study aimed to compare their prognostic effects in terms of complications and in-hospital mortality.

Method: A cross-sectional study was conducted on 91 ACS patients (STEMI, NSTEMI, UA) admitted to a tertiary care hospital over 18 months. Patients with admission random blood sugar (RBS) >140 mg/dL were included in the study. Based on Glycosylated hemoglobin (HbA1c) levels, patients were categorized into the stress glycemic group (HbA1c <6.5) and the diabetic group (HbA1c ≥6.5). Outcomes were analyzed until discharge or death.

Results: Among the study population, 63.74% were male, and 36.26% were female. Cardiogenic shock occurred in 41.76% of patients, with a significantly higher prevalence in the stress glycemic group (73.68%) compared to the diabetic group (26.32%). Heart failure was observed in 61.54% of patients, predominantly in the stress glycemic group (64.29%) versus the diabetic group (35.71%). Arrhythmias affected 28.57% of patients, with a higher prevalence in the stress glycemic group (76.92%) compared to the diabetic group (23.08%). In-hospital mortality was 29.67%, with significantly higher mortality in the stress glycemic group (74.07%) compared to the diabetic group (25.93%).

Conclusion: Hyperglycemia at admission in ACS patients, particularly stress hyperglycemia, is associated with severe complications and increased mortality compared to diabetes mellitus. Regular monitoring and management of blood glucose levels in non-diabetic ACS patients are crucial to improve outcomes. Further research with long-term follow-up is warranted.

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References

Bernard C. Lessons from Experimental Physiology Applied to the Medicine. Paris: Balliere; 1855. p. 296-313.

Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer RG, et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004 Feb 1;27(2):553-91.

Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: A systematic overview. Stroke. 2001 Oct 1;32(10):2426-32.

Deedwania P, Kosiborod M, Barrett E, Ceriello A, Isley W, Mazzone T, et al. Hyperglycemia and acute coronary syndrome: A scientific statement from the American Heart Association Diabetes Committee of the Council on Nutrition, physical activity, and metabolism. Circulation. 2008 Mar 25;117(12):1610-9.

Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: Current epidemiology and future directions. Circulation. 2016;133(16):1605-20.

Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: A systematic overview. Lancet. 2000;355(9206):773-8.

Timmer JR, van der Horst IC, Ottervanger JP, Henriques JP, Hoorntje JC, de Boer MJ, et al. Prognostic value of admission glucose in non-diabetic patients with myocardial infarction. Am Heart J. 2004;148(3):399-404.

Cheung NW, Wong VW, McLean M. The hyperglycemia: Intensive insulin infusion in infarction (HI-5) study: A randomized controlled trial of insulin infusion therapy for myocardial infarction. Diabetes Care. 2006;29(4):765-70.

Timmer JR, Ottervanger JP, de Boer MJ, Dambrink JH, Hoorntje JC, Gosselink AM, et al. Hyperglycemia is an important predictor of impaired coronary flow before reperfusion therapy in ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2005 Apr 5;45(7):999-1002.

Cinar H, Avci A, Gulen M, Avci BS, Comertpay E, Satar S. Does stresshyperglycemia affect mortality? Acute myocardial infarction-case control study. Arch Med Sci Atheroscler Dis. 2019;4:e201-7.

Aggarwal RC, Goyal M, Sikri H, Sikri T, Neki NS. Prognostic value of stress hyperglycemia in acute coronary syndrome in non-diabetic patients. Int J Curr Res Med Sci. 2017;3(4):7-13.

Kadri Z, Danchin N, Vaur L, Cottin Y, Guéret P, Zeller M, et al. Major impact of admission glycaemia on 30 day and one year mortality in non-diabetic patients admitted for myocardial infarction: Results from the nationwide French USIC 2000 study. Heart. 2006 Jul 1;92(7):910-5.

Sanjuan R, Núñez J, Blasco ML, Miñana G, Martínez-Maicas H, Carbonell N, et al. Prognostic implications of stress hyperglycemia in acute ST elevation myocardial infarction. Prospective observational study. Rev Esp Cardiol. 2011 Mar 1;64(3):201-7.

Na Z, Zhen L. GW25-e0795 relationship between stress hyperglycemia and in hospital mortality and complications in patients with acute myocardial infarction. J Am Coll Cardiol. 2014 Oct 21;64(16S):C126.

Mak KH, Mah PK, Tey BH, Sin FL, Chia G. Fasting blood sugar level: A determinant for in-hospital outcome in patients with first myocardial infarction and without glucose intolerance. Ann Acad Med Singap. 1993 May 1;22(3):291-5.

Goyal A, Mehta SR, Gerstein HC, Díaz R, Afzal R, Xavier D, et al. Glucose levels compared with diabetes history in the risk assessment of patients with acute myocardial infarction. Am Heart J. 2009 Apr;157(4):763-70. doi: 10.1016/j.ahj.2008.12.007

Hsu CW, Chen HH, Sheu WH, Chu SJ, Shen YS, Wu CP, et al. Initial serum glucose level as a prognostic factor in the first acute myocardial infarction. Ann Emerg Med. 2007 May;49(5):618-26. doi: 10.1016/j. annemergmed.2006.10.023, PMID: 17178170