Assessment of and physician response to glycemic control in diabetic patients presenting with an acute coronary syndrome

Aim: To find the frequency of recently poor glycemic control as assessed by HbA1c in diabetic patients with acute coronary syndrome Study design & Setting: Observational study. Methods: The study included 60 diabetic patients presented with acute coronary syndrome. Diagnosis of acute coronary syndrome was based on patient’s symptoms, ECG changes and cardiac enzyme results. HBA1c level report was collected for all patients from their hospital record. SPSS 21 version was used to analyze the collected data. The qualitative data was presented in the form of graphs while the quantitative data was presented by simple descriptive statistics in the form of mean, range and standard deviation. Results: Out of sixty patients enrolled in this study 2(45%) were females and 33(55%) were males. 28(46.67%) patients presented with ST-elevation MI (STEMI) whereas 25(41.66%) patients presented with non ST-elevation MI. 7(11.66%) had unstable angina. Out of sixty patients 21(35%) patients were having poor glycemic control (HBA1C >7%) whereas 39(65%) patients had fair glycemic control (HBA1C< 7%). Fifty eight (96%) patients were using oral anti diabetic tablets whereas 2(3.33%) patients were using insulin before hospital admission. Conclusion: This study shows that amongst patients admitted with acute coronary syndrome a significant proportion of patients (35%) had poor glycemic control over past three months as assessed by HBA1C implying that recent poor glycemic control is a significant risk factor for acute coronary events in diabetic patients. Keywords: Acute coronary syndrome, Glycemic control, Diabetes mellitus.

Download Full-text

Role of Tight Glycemic Control during Acute Coronary Syndrome on CV Outcome in Type 2 Diabetes

Journal of Diabetes Research ◽

10.1155/2018/3106056 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Ferdinando Carlo Sasso ◽

Luca Rinaldi ◽

Nadia Lascar ◽

Aldo Marrone ◽

Pia Clara Pafundi ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Glycemic Control ◽

Molecular Mechanisms ◽

Tight Glycemic Control ◽

Left Ventricular ◽

Diabetic Patients ◽

Coronary Syndrome ◽

Hexosamine Pathway ◽

Incidence And Mortality

Both incidence and mortality of acute coronary syndrome (ACS) among diabetic patients are much higher than those among nondiabetics. Actually, there are many studies that addressed glycemic control and CV risk, whilst the literature on the role of tight glycemic control during ACS is currently poor. Therefore, in this review, we critically discussed the studies that investigated this specific topic. Hyperglycemia is implicated in vascular damage and cardiac myocyte death through different molecular mechanisms as advanced glycation end products, protein kinase C, polyol pathway flux, and the hexosamine pathway. Moreover, high FFA concentrations may be toxic in acute ischemic myocardium due to several mechanisms, thus leading to endothelial dysfunction. A reduction in free fatty acid plasma levels and an increased availability of glucose can be achieved by using a glucose-insulin-potassium infusion (GIKi) during AMI. The GIKi is associated with an improvement of either long-term prognosis or left ventricular mechanical performance. DIGAMI studies suggested blood glucose level as a significant and independent mortality predictor among diabetic patients with recent ACS, enhancing the important role of glucose control in their management. Several mechanisms supporting the protective role of tight glycemic control during ACS, as well as position statements of Scientific Societies, were highlighted.

Download Full-text

Abstract 12188: Intensive Glycemic Control in Patients With Acute Coronary Syndrome: Evidence From a Meta-Analysis

Circulation ◽

10.1161/circ.130.suppl_2.12188 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Partha Sardar ◽

Ramez Nairooz ◽

Saurav Chatterjee ◽

Jacob A Udell ◽

Dharam J Kumbhani ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Glycemic Control ◽

Meta Analysis ◽

Random Effect ◽

Intensive Glucose Control ◽

Intensive Glycemic Control ◽

Coronary Syndrome ◽

All Cause Mortality ◽

Glucose Management ◽

Management Groups

Introduction: Hyperglycemia is associated with unfavorable prognosis in patients with acute coronary syndrome (ACS). Studies with intensive glycemic control in ACS patients have provided inconsistent results. A meta-analysis was performed to evaluate the effectiveness and safety of intensive glycemic control in patients with ACS. Methods: Search of PubMed, Cochrane CENTRAL, EMBASE, EBSCO, Web of Science and CINAHL databases from their inception through April 2014, identifying randomized controlled trials (RCTs) comparing the effects of intensive versus standard glucose management in patients with ACS. We calculated summary random-effect odds ratios (OR) and 95% confidence intervals (CI). Results: Results from 10 RCTs comprising 2,621 patients were analyzed. All-cause mortality between intensive versus standard glucose management groups did not differ significantly (OR 1.00, 95% CI 0.75-1.34). Similarly, no significant differences were observed between the comparator groups for the odds of cardiac mortality (OR 0.87, 95% CI, 0.67 to 1.12), recurrent myocardial infarction (OR 1.07, 95% CI, 0.76 to 1.52), or stroke (OR 1.20, 95% CI, 0.60 to 2.40). The risk of hypoglycemia (OR 5.95, 95% CI, 2.73 to 12.97; p<0.001) was significantly higher with intensive compared with standard glucose management. Conclusions: Intensive glucose control compared with standard care in ACS patients did not reduce mortality or morbidity, but significantly increased the risk of hypoglycemia. These data from prior clinical trials should be interpreted in the context of their significant methodological limitations.

Download Full-text

Comparison of Ticagrelor Versus Prasugrel for Inflammation, Vascular Function, and Circulating Endothelial Progenitor Cells in Diabetic Patients With Non–ST-Segment Elevation Acute Coronary Syndrome Requiring Coronary Stenting

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2017.05.064 ◽

2017 ◽

Vol 10 (16) ◽

pp. 1646-1658 ◽

Cited By ~ 40

Author(s):

Han Saem Jeong ◽

Soon Jun Hong ◽

Sang-A Cho ◽

Jong-Ho Kim ◽

Jae Young Cho ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Progenitor Cells ◽

Endothelial Progenitor Cells ◽

Vascular Function ◽

Coronary Stenting ◽

Diabetic Patients ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Circulating Endothelial Progenitor Cells ◽

St Segment

Download Full-text

Impact of Total Risk Management on Coronary Plaque Regression in Diabetic Patients with Acute Coronary Syndrome

Journal of Atherosclerosis and Thrombosis ◽

10.5551/jat.31948 ◽

2016 ◽

Vol 23 (8) ◽

pp. 922-931 ◽

Cited By ~ 7

Author(s):

Ryo Naito ◽

Katsumi Miyauchi ◽

Hiroyuki Daida ◽

Takeshi Morimoto ◽

Takafumi Hiro ◽

...

Keyword(s):

Risk Management ◽

Acute Coronary Syndrome ◽

Coronary Plaque ◽

Diabetic Patients ◽

Total Risk ◽

Coronary Syndrome ◽

Plaque Regression

Download Full-text

The Threshold of Admission Glycemia as a Predictor of Adverse Events in Diabetic and Non-Diabetic Patients with Acute Coronary Syndrome

Clinical medicine Cardiology ◽

10.4137/cmc.s2289 ◽

2009 ◽

Vol 3 ◽

pp. CMC.S2289 ◽

Cited By ~ 3

Author(s):

Taysir S. Garadah ◽

Salah Kassab ◽

Qasim M. Al-Shboul ◽

Abdulhai Alawadi

Keyword(s):

Acute Coronary Syndrome ◽

Adverse Events ◽

Diabetic Patients ◽

Stress Hyperglycemia ◽

Coronary Syndrome ◽

History Of ◽

Group 3 ◽

Group 2 ◽

High Level ◽

Group 1

Recent studies indicated a high prevalence of hyperglycemia in non-diabetic patients presenting with acute coronary syndrome (ACS). However, the threshold of admission glucose (AG) as a predictor of adverse events in ACS is unclear. Objective The aim of this study was to assess the threshold of admission glucose (AG) as a predictor of adverse events including Major Acute Cardiac Events (MACE) and mortality, during the first week of admitting patients presenting with ACS. Material and Methods The data of 551 patients with ACS were extracted and evaluated. Patients were stratified according to their blood glucose on admission into three groups: group 1: <7 mmol/L (n = 200, 36.3%) and group 2: >7 mmol/L and <15 mmol/L (n = 178, 32.3%) and group 3: ≥15 mmol/L (n = 173, 31.4%). Stress hyperglycemia was arbitrarily defined as AG levels > 7 mmol/L (group 2 and 3). Patients with ACS were sub-divided into two groups: patients with unstable angina (UA, n = 285) and those with ST segment elevation myocardial Infarction (STEMI, n = 266) and data were analyzed separately using multiple regression analysis. Results The mean age of patients was 59.7 ± 14.8 years and 63% were males. The overall mortality in the population was 8.5% (5.4% in STEMI and 3.1% in UA) patients. In STEMI patients, the odds ratio of stress hyperglycemia as predictor of mortality in group 3 compared with group 1 was 3.3 (CI 0.99-10.98, P < 0.05), while in group 2 compared with group 1 was 2.4 (CI: 0.75-8.07, P = 0.065) after adjustment for age and sex. Similarly, in UA patients, the odds ratio of stress hyperglycemia in group 3 compared with group 1 was 2.7 (CI 0.37-18.98, P < 0.05), while in group 2 compared with group 1 was 2.4 (CI: 0.4-15.2, P = 0.344) after adjustment for age and sex. The incidence of more than 2 MACE in both STEMI and UA patients was higher in group 3 compared with the other two groups. Regression analysis showed that history of DM, high level of LDL cholesterol, high level of HbA1c, and anterior infarction were significant predictors of adverse events while other risk factors such as BMI, history of hypertension and smoking were of no significance. Conclusion This study indicates that the stress hyperglycemia on admission is a powerful predictor of increased major adverse events and hospital mortality in patients with acute coronary syndrome.

Download Full-text

Coronary Artery Involvement in Diabetic and Non-Diabetic Patients with Acute Coronary Syndrome: A Case Control Study

Journal of Cardiovascular Medicine and Surgery ◽

10.21088/jcms.2454.7123.6120.4 ◽

2020 ◽

Vol 6 (1) ◽

pp. 24-28

Author(s):

Ravindranath Reddy DR ◽

◽

Mithun Somaiah CS ◽

Mohan ME ◽

◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Case Control Study ◽

Case Control ◽

Diabetic Patients ◽

Coronary Syndrome ◽

Coronary Artery Involvement ◽

Control Study

Download Full-text

Safety and efficacy of bivalirudin in diabetic acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI)

European Heart Journal ◽

10.1093/eurheartj/ehab724.1437 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Golam Mostofa ◽

T Parvin ◽

R Masum Mandal ◽

S Ali Ahsan ◽

R Afrin

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Major Bleeding ◽

Guide Wire ◽

Coronary Intervention ◽

Diabetic Patients ◽

Safety And Efficacy ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Hemorrhagic Complications

Abstract Background Prevention of hemorrhagic complications has emerged as a priority in patients undergoing Percutaneous Coronary Intervention (PCI) in addition to suppressing thrombotic complications. This goal is challenging to achieve in diabetic Acute Coronary Syndrome (ACS) patients as Diabetes Mellitus (DM) itself is a prothrombotic state with more pronounced vascular injury response and have a worse outcome after PCI compared with non-diabetic patients. In patients with ACS, Bivalirudin has been shown to result in similar rates of composite ischemia as Heparin plus GPI (GP IIb /IIIa inhibitor), while significantly reducing major bleeding and has received class I recommendation for PCI by American College of Cardiology (ACC 2013). Whether Bivalirudin is safe and effective specially in diabetic ACS patients undergoing PCI, as compared with Heparin (UFH) monotherapy, is unknown. Purpose To determine and compare the incidence of in-hospital and 30-day hemorrhagic complications and major adverse cardiac events (MACEs) as evidence of safety and efficacy using Bivalirudin versus Heparin in diabetic ACS patients undergoing PCI. Methods 218 diabetic ACS patients (age>18 years and ≤75 years) who underwent PCI from May 2018 to April 2019 at University Cardiac Centre, BSM Medical University, Dhaka, Bangladesh were randomly assigned to have UFH or Bivalirudin. Before the guide wire crossed the lesion, 111 patients in the UFH group received a bolus of 70–100 U/kg (targeted activated clotting time, ACT: 200–250 s). 107 patients in the Bivalirudin group received a loading dose of 0.75 mg/kg, followed by an infusion of 1.75 mg/kg/h for up to 4 hours. Dual antiplatelet (DAPT) loading as Aspirin 300 mg plus P2Y12 inhibitors (Clopidogrel 600 mg or Prasugrel 60 mg or Ticagrelor 180 mg) was given in all patients before the procedure. The maintenance dose of DAPT was continued for at least one month and patients were followed telephonically up to 30 days. The outcome measures were in-hospital and 30-day hemorrhagic complications and MACEs [death, MI, target vessel revascularization (TVR) and stroke]. Results Patients treated with Bivalirudin compared with Heparin had a significantly lower in-hospital incidence of QMI (0% vs. 6%; p=0.03) and major bleeding (0% vs. 7%; p=0.02). However, the incidence of cardiac death, stent thrombosis, TVR were no differences between two groups (p>0.05). There was only one NQMI in the Bivalirudin group as opposed to 8% in the Heparin group in 30 days following stenting (p=0.04). Conclusion In diabetic ACS patients undergoing PCI, Bivalirudin is safe and effective as it reduces immediate and short-term hemorrhagic complications as well as MACEs as compared with Heparin. FUNDunding Acknowledgement Type of funding sources: None.

Download Full-text