DOI: http://dx.doi.org/10.18203/2349-3933.ijam20192241

Role of HbA1c with mortality and severity among the patients of Acute coronary syndrome: a prospective study

Satish Chandel, Shishirendu Parihar, Bharat Gramani, T. N. Dubey

Abstract


Background: Blockage of coronary artery lead to a reduction of blood flow towards heart resulting in Coronary Artery Disease (CAD). CAD leads to myocardial complications. CAD is one of the important causes of death all over the world including India. Diabetes mellitus is a risk factor for CAD. Reports have also shown to increase in cardiovascular morbidity among patients with glucose intolerance. In present study we tried to find the relationship of HbA1c levels with mortality, morbidity, and severity in Acute Coronary Syndrome (ACS).

Methods: Two hundred patients with ACS were studied from 2018 to 2019 at Gandhi Medical College and Hamidia Hospital, Bhopal. Following a thorough medical history routine medical examination including laboratory investigations was performed in all the patients. Electrocardiography (ECG), creatine phosphokinase-muscle/brain (CPK-MB), echocardiography and coronary angiography (CAG) was also done as part of this study.

Results: Mean age of the study cohort was 59.17±8.75 years. Out of 200 subjects, 110 (55%) were non-diabetic, 52 (26%) were diabetic, 38 (19%) had weakened glucose tolerance and 82 (41%) had hypertension. Left ventricular dysfunction (LVD) and heart failure (HF) were the common complications and were more prevalent among diabetic patients than the nondiabetics (p=0.009). HbA1c level (7.01±2.23) was high among subjects with complications than the subjects without complications (6.01±1.36).

Conclusions: The patients with DM have higher morbidity and mortality than the non-diabetic patients of ACS and therefore such patients should be screened for diabetes and glucose intolerance for better management of CAD.


Keywords


Coronary Artery Disease, Coronary Angiography, Diabetes Mellitus, Stress Hyperglycemia

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References


Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. GBD 2013 Mortality and Causes of Death Collaborators. Lancet. 2015;385:117.

Preis SR, Hwang SJ, Coady S. Trends in all-cause and cardiovascular disease mortality among woman and men with and without diabetes mellitus in the Framingham heart study, 1950 to 2005. Circulation. 2009;1728:119-23.

Gore MO, Patel MJ, Kosiborod M. Diabetes mellitus and trends in hospital survival after myocardial infarction, 1994 60 2006: data from a national registry of Myocardial Infarction. Circ Cardiovasc Qual Outcomes. 2012;791:5-9.

Saunders J, Mathewkutty S, Drazner MH, McGuire DK. Cardiomyopathy in type 2 diabetes; Update on pathophysiology mechanism. Herz. 2008;184:33-8.

Kannel WB, McGee DL. Diabetes and cardiovascular risk factors: the Framingham study. Circulation. 1979;59:8-11.

Selvin E, Marinopoulos S, Berkenblit G. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Annals Int Med. 2004;141:421-31.

Khaw KT, Wareham N, Bingham S, Luben R, Welch A. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med. 2004;141:413-20.

Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes Care. 1999;22:233239.

Stone PH, Muller JE, Hartwell T, York BJ, Rutherford JD, Parker CB, et al. The effect of diabetes mellitus on prognosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. The MILIS Study Group. J Am Coll Cardiol. 1989;14:49-51.

Iribarren C, Karter AJ, Go AS, Ferrara A, Liu JY, Sidney S, Selby JV. Glycemic control and heart failure among adult patients with diabetes. Circulation. 2001;103:2668-72.