Clinical significance of hyperglycaemia in Acute Coronary Syndrome patients

Zh.Cherneva1, S. Denchev1, R. Ivanova1, M. Gospodinova1, M. Genova2, R. Cherneva3
1Department of Cardiology, 2Department of  Clinical Laboratory, 3Department of  Internal diseases, Sofia, Bulgaria

Background

The clinical significance of moment measurements (admission and fasting glycaemia), persistent (hyperglycaemic index – HGI, time average glucose – TAG, mean glucose, maximum glucose) or chronic hyperglycaemia (HbA1c, estimated average glucose – eAG) is still elusive in clinical practice

Objectives

To identify the clinical significance of all types of hyperglycaemia in ACS population as a surrogate marker for ventricular systolic dysfunction, enzymes for myocardial necrosis, impairment in glucose metabolism and as a prognostic factor for 6-month and 1-year outcome.

Materials & Methods

The study included 226 consecutive patients with ACS, admitted to the Clinic of Cardiology, University Hospital Aleksandrovska”, Sofia, III.2009 -VIII 2010. Indicators for moment, persistent and chronic hyperglycaemia were calculated. A correlation analysis with EF, maximum CK, maximum CK-MB and troponin was performed. One hundred sixty-five of the patients had PCI at admission. Patients were followed up for 12 months.

Results

Indicators for persistent and chronic hyperglycaemia correlated neither to EF, nor to the enzymes for myocardial necrosis (p>0,05). In contrast, acute hyperglycaemia correlated negatively with EF (p=0,001/0.007) and positively with maximum CK, CK-MB and troponin (p=0,0001/0.008). TAG was an independent predictor for 6-month rehospitalization (p=0.027) because of cardiac events. No difference was found in indicators for hyperglycaemia between patients with STEMI/Unstable angina and newly diagnosed impaired glucose tolerance. There was statistical difference only in acute (fasting glycaemia – p=0.025) and chronic hyperglycaemia (HBA1c; eAG = p-0.002) between patients with STEMI/Unstable angina and newly diagnosed diabetes.

Conclusion

Glycaemia at admission and fasting glucose could be used as metabolic surrogate markers for ventricular systolic dysfunction. TAG could serve as an independent surrogate  marker for 6-month rehospitalization. None of the indicators for hyperglycaemia could be used as independent prognostic factors for short- and long-term survival. Hyperglycaemia rather reflects an underlying impairment in glucose metabolism.

Background

The clinical significance of moment measurements (admission and fasting glycaemia), persistent (hyperglycaemic index – HGI, time average glucose – TAG, mean glucose, maximum glucose) or chronic hyperglycaemia (HbA1c, estimated average glucose – eAG) is still elusive in clinical practice.

Objectives

To identify the clinical significance of all types of hyperglycaemia in ACS population as a surrogate marker for ventricular systolic dysfunction, enzymes for myocardial necrosis, impairment in glucose metabolism and as a prognostic factor for 6-month and 1-year outcome.

Materials & Methods

The study included 226 consecutive patients with ACS, admitted to the Clinic of Cardiology, University Hospital Aleksandrovska”, Sofia, III.2009 -VIII 2010. Indicators for moment, persistent and chronic hyperglycaemia were calculated. A correlation analysis with EF, maximum CK, maximum CK-MB and troponin was performed. One hundred sixty-five of the patients had PCI at admission. Patients were followed up for 12 months.

Results

Indicators for persistent and chronic hyperglycaemia correlated neither to EF, nor to the enzymes for myocardial necrosis (p>0,05). In contrast, acute hyperglycaemia correlated negatively with EF (p=0,001/0.007) and positively with maximum CK, CK-MB and troponin (p=0,0001/0.008). TAG was an independent predictor for 6-month rehospitalization (p=0.027) because of cardiac events. No difference was found in indicators for hyperglycaemia between patients with STEMI/Unstable angina and newly diagnosed impaired glucose tolerance. There was statistical difference only in acute (fasting glycaemia – p=0.025) and chronic hyperglycaemia (HBA1c; eAG = p-0.002) between patients with STEMI/Unstable angina and newly diagnosed diabetes.

Correlation between moment, persistent, chronic hyperglycaemia and clinical parameters

Correlation between moment, persistent, chronic hyperglycaemia and six-month/one -year clinical outcome

Conclusion

Glycaemia at admission and fasting glucose could be used as metabolic surrogate markers for ventricular systolic dysfunction. TAG could serve as an independent surrogate  marker for 6-month rehospitalization. None of the indicators for hyperglycaemia could be used as independent prognostic factors for short- and long-term survival. Hyperglycaemia rather reflects an underlying impairment in glucose metabolism.