Diabetes in acute coronary syndrome patients: do we see only the tip of the iceberg?

Vavlukis, Marija and Kamceva, Gordana and Kitanoski, Darko and Pocesta, Bekim and Caparovska, Emilija and Taravari, Hajber and Shehu, Enes and Bojovski, Ivica and Janusevski, Filip and Taneski, Filip and Kotlar, Irina and Kedev, Sasko (2015) Diabetes in acute coronary syndrome patients: do we see only the tip of the iceberg? In: Accute Cardiac Care, 2015, 17-19 October, 2015, Vienna, Austria.

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Aim of the study: To analyse the influence of glycoregulation in pts. with known or newly detected diabetes, on in-hospital morbidity/mortality in patients with acute coronary syndrome. Methods: randomly selected ACS patients were analysed for: stress glycaemia, HgbA1c, risk profile, lipid profile, SINTAX score, TIMI flow, LV function and in-hospital morbidity/mortality. We comparatively analysed pts. based on the level of HgbA1c (⩾ 6,5% vs <6,5%), and subdivided in five groups: without known diabetes: non-diabetic (NonD), pre-diabetic (PD), new diabetic (ND), and known diabetes: controlled (CD) and uncontrolled (UD). Results: 116 patients were included, 64.7% m. and 35.3% f., mean age 62±12y. HTA was present in 51%, HLP in 6.3%, Positive phamily history in 36.3%, and 61.4% were smokers. 33.6%) patients had known diabetes, 28 (24.1%) had newly detected pre-diabetes (HgbA1c 5.6-6.5%), and 16 (13.8%) had diabetes (HgbA1c >6.5%). Mean values of HgbA1c and stress glycaemia were as follows: NonD - 5.19±0.56 and 6.82±1.87; PD - 5.99±0.19 and 8.32±3.17; ND - 8.19±1.15 and 17.68.19±1.15; CD - 5.79±0.55 and 8.89±4.38; and UD - 9.36±1.33 and 16.23±6.24; (ANOVA p >0.000). No significant difference was found between NonD and CD pts., and between ND and UD (high in the last two), but there was significant difference in HgbA1c (p<0.000). We found high positive correlation between stress glycaemia and HgbA1c: r = 0.636, p>0.000, Kappa agreement (0.516; sig p>0.000). TG levels were increased only in UD, and ND groups: 1.93±1.06, and 2.36±1.22, (ANOVA p=0.026, Tukey test ND vs NonD p=0.050; and vs PD p=0.016), without significant difference in other lipid fractions. Mean SINTAX score was 15.45±8.2, without significant inter-gorup differences. TIMI flow before PCI significantly differed across the groups, the lowest being in ND - 0.14±0.36 and PD - 1.13±1.42 pts. (group value 1.37±1.42; ANOVA p=0.001; Tukey test: NonD vs ND 0.000; and 0.043 vs CD). Mean EF was 51.51±8.5, without significant inter-group difference. 29 in-hospital events in 22 (19%) patients were registered: 7.7% arrhythmias, 6.9% heart failure, 3.4% GIT bleedings, and 2.6% CVI. In-hospital mortality was 4.3%. In multivariate logistic regression analysis, ejection fraction, stress glycaemia, and HgbA1c were identified as independent predictors of in-hospital outcome. Conclusion: High prevalence of unknown diabetes in ACS patients exists, leading to worse CAD, even in comparison with pts with known, well controlled diabetes. Stress glycaemia, HgbA1c and ejection fraction are independent predictors of in-hospital morbidity/mortality.

Item Type: Conference or Workshop Item (Paper)
Subjects: Medical and Health Sciences > Clinical medicine
Divisions: Faculty of Medical Science
Depositing User: Marija Vavlukis
Date Deposited: 24 Nov 2015 10:28
Last Modified: 24 Nov 2015 10:28
URI: https://eprints.ugd.edu.mk/id/eprint/14322

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