The aim of our study is to determine the association between stress hyperglycemia (HG) and the occurrence of coronary occlusion or multiple vessel disease, as well as its relationship with the development of in-hospital complications, in patients admitted with an acute coronary syndrome (ACS).
Blood glucose and C-reactive protein (CRP) were measured in 550 patients on admission and 24 hours later. Creatinin-Kinase (CK) and CK-MB were charted every 6 hours. HG was considered if the value was above 110 mg%. Coronarography was immediately performed to evaluate coronary artery disease in patients who needed a primary angioplasty (PCI) after their admission, and within 72 hours in other patients. Wall motion score (WMS) of the16 left ventricular segments and Ejection Fraction (EF) were evaluated by echocardiography and nuclear angiography during the first 48 hours after the acute cardiac event. Student-t test was used for statistics.
88% of patients with ACS had no history of Diabetes and HG was detected in 445/550 patients (81%). HG above 125 mg/dl was found in 75% of the latter (333/445) and it was significantly associated with the occlusion of at least one of the three main coronary arteries or the occurrence of multiple vessel disease in angiography (p<0.005). The peaks of CK, CK-MB and CRP (but not WMS and EF), were also correlated with HG above 125 mg/dl (p<0.005). Higher incidence of heart failure, shock, recurrence of angina and mortality rate in-hospital was observed in patients with HG (p<0.005). However, PCI reduced significantly the mortality of those patients who had myocardial infarction and HG (p<0.005).CONCLUSIONS: On admission, HG above 125 mg/dl can predict the occurrence of coronary occlusion and multiple vessel disease in patients with ACS. HG also associates with a high risk to develop heart failure and a higher mortality, and more aggressive treatment is needed to treat these patients on their admission.
N. D Nguyen, None.