The relationship between acute coronary syndrome and stress hyperglycemia
1Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University.
Insights
Stress hyperglycemia (SH) in acute coronary syndrome (ACS) patients is linked to worse outcomes, including more extensive coronary artery disease (CAD) and higher rates of major adverse cardiac events (MACE). Early identification of SH is crucial for better patient prognosis.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- Admission hyperglycemia is a known risk factor for mortality and morbidity in acute coronary syndrome (ACS).
- Limited evidence exists on the relationship between stress hyperglycemia (SH) and the extent of coronary artery disease (CAD).
Purpose of the Study:
- To assess the relationship of SH with the prognosis of ACS.
- To evaluate the association of SH with the extent of CAD.
- To determine the impact of SH on arrhythmia development and major adverse cardiac events (MACE).
Main Methods:
- 89 patients hospitalized with ACS were divided into SH and non-SH groups based on admission blood glucose levels.
- TIMI and GRACE risk scores were calculated; GENSINI scoring assessed CAD extent.
- MACE (death, MI, re-vascularization, stroke) were recorded during hospitalization and at 1 and 6 months.
Main Results:
- Patients with SH exhibited significantly higher MACE rates, higher GENSINI scores at 6 months, and increased in-hospital arrhythmia development.
- Lower left ventricular ejection fractions were observed in the SH group.
- Confirmed associations between blood glucose levels (including HbA1c) and various clinical classifications (TIMI, GRACE, GENSINI, NYHA, Killip).
Conclusions:
- SH is associated with a worse prognostic course and more extensive CAD in ACS patients.
- The findings suggest that diagnostic thresholds for SH may need adjustment compared to existing literature.
- Early recognition and management of SH in ACS are critical for improving patient outcomes.
Background And Objective:
Hyperglycemia on admission is associated with increased mortality and morbidity in acute coronary syndrome (ACS) irrespective of presence of diabetes mellitus. To the best of our knowledge, no evidence on the relationship between stress hyperglycemia (SH) and the extent of coronary artery disease is found in the literature. Our objective in this study is to assess the relationship of SH with the prognosis of acute coronary syndrome, extent of coronary artery disease (CAD), development of arrhythmia, and major adverse cardiac events.
Method:
89 patients who were hospitalized in the coronary intensive care unit with diagnosis of ACS between January 2010 and June 2010 were enrolled in the study. The patients were separated into 2 groups as having stress hypergly-cemia or not, according to their blood glucose levels on admission. TIMI and GRACE risk scores were obtained and GENSINI scoring was performed to assess CAD extent for all the patients. Major adverse cardiac events (MACE) (death, MI, re-revascularization, stroke) were recorded for all patients while in the hospital and at 1st and 6th months.
Results:
In our study, MACE, GENSINI scores at 6 months and development of in-hospital arrhythmia rates were statistically significantly higher and left ventricular ejection fractions were statistically significantly lower in the group with SH. The association of TIMI, GRACE, GENSINI, New York Heart Association (NYHA) and Killip classifications with blood glucose, fasting blood glucose and HbA1c on admission was confirmed.
Conclusion:
Prognostic course happens to be worse and CAD is more extensive in patients with SH. In addition, blood glucose values may have to be estimated lower compared to the samples in the literature, in order to diagnose SH.
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