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

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
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.

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

2019 ◽  
Vol 6 (3) ◽  
pp. 796
Author(s):  
Satish Chandel ◽  
Shishirendu Parihar ◽  
Bharat Gramani ◽  
T. N. Dubey
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Glucose Intolerance ◽  
Left Ventricular ◽  
Diabetic Patients ◽  
Study Cohort ◽  
Medical College ◽  
Coronary Syndrome ◽  
Gandhi Medical College ◽  
A Prospective Study

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.

Abstract 14068: One-year Outcomes of Dpp-4 Inhibitor Treatment in Diabetic Patients After Contemporary Percutaneous Coronary Intervention - Ps Matching From Data of Multicenter Registry -

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Takehiro Hata ◽  
Kentaro Jujo
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diabetic Patients ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Dipeptidyl Peptidase 4 Inhibitors

Introduction: Clinical prognosis in diabetic patients comorbid with coronary artery disease (CAD) remained poor, even in the current drug-eluting stent (DES) era. However, there has been a limited evidence about the prognosis in diabetic patients with CAD who were treated with dipeptidyl peptidase-4 inhibitors (DPP4i). Methods: This study is a subanalysis from the TWINCRE registry that is a multicentral prospective cohort including patients who underwent percutaneous coronary intervention (PCI) at 12 hospitals in Japan between 2017 and 2019. Among 1,905 registered patients who were followed up, we ultimately evaluated 615 diabetic patients. They were divided into two groups depending on the prescription of DPP4i at the hospital discharge after the index PCI; DPP4i group (n=287) and Non-DPP4i group (n=328). For the two groups, we performed propensity-score (PS) matching using variables as follows: age, sex, acute coronary syndrome, left ventricular ejection fraction, serum creatinine, insulin use, prescriptions of statin, beta blocker, aspirin, and ACE inhibitor/ARB. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) including death, acute coronary syndrome, stent thrombosis, hospitalization due to heart failure and ischemic stroke. Results: Overall MACCE was observed in 70 patients (11.4%) during 364 days of median observation period. In unmatched patients, Kaplan-Meier analysis showed that patients in the DPP4i group showed a significantly lower MACCE rate than those in the Non-DPP4i group (Log-rank test, p=0.009, Figure A). In 284 PS-matched patients, patients in the DPP4i group still had lower MACCE rate than those in the non-DPP4i group (hazard ratio 0.39, 95% confidence interval 0.16-0.96, p=0.034, Figure B). Conclusion: Propensity-matching analysis showed that hyperglycemia control by DPP4i was associated with better 1-year clinical outcomes in diabetic patients after PCI in the contemporary DES era.

Role of Segmental and Global Left Ventricular Strain in Diagnosis of Acute Coronary Syndrome

Kardiologiia ◽  
2020 ◽  
Vol 60 (5) ◽  
pp. 20-24
Author(s):  
A. L. Chilingaryan ◽  
L. G. Tunyan ◽  
R. V. Shamoyan
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Sensitivity And Specificity ◽  
False Negative ◽  
Left Ventricular ◽  
Middle Part ◽  
Control Group ◽  
Acute Ischemia ◽  
Coronary Syndrome

Aim To determine the role of left ventricular segmental (SLS) and general longitudinal strain (GLS) in early diagnosis of acute coronary syndrome (ACS).Material and methods The study included 112 patients aged 58±7 years with suspected ACS without a history of ischemic heart disease (IHD) who were admitted to the hospital within 12 h of complaint onset. The control group consisted of 20 healthy, age- and sex-matched subjects. Speckle-tracking echocardiography was performed to assess SLS and GLS on admission and discharge. Ischemia was diagnosed when the SLS was decreased to 14% or lower with a simultaneous post-systolic shortening (PSS) of these segments >20% or when the initial lengthening of the segments was followed by PSS.Results Decreased SLS with PSS of one or more segments was observed in 51.8 % of patients; 16.1% of patients had initial systolic lengthening of one or more segments followed by PSS. In 30.3 % of patients, GLS was 15.5 % or less; 82.3% of these patients had SLS disorders. Later, ACS was diagnosed in 72.3 % of the patients. ACS was not confirmed in 4 (5.2%) of 76 (67.9 %) patients with abnormal SLS changes. All these patients had low SLS values and high PSS values and did not have the initial systolic segmental lengthening. Seven of 9 (8 %) patients with false-negative SLS values had distal narrowing of a coronary artery and two patients had narrowing in the middle part of the artery. All patients with ACS and decreased GSL had a hemodynamically significant narrowing of more than one coronary artery. Incidence of two and more stenosed arteries was higher in patients with PSS and low GSL. Sensitivity and specificity of SLS for diagnosis of acute ischemia were 88.9 and 84.6 %, respectively.Conclusion Assessment of LV strain has high sensitivity and specificity for diagnosis of ACS in patients with the first IHD episode. The presence of PSS associated with decreased GSL may indicate multivascular IHD.

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

2006 ◽  
Vol 152 (6) ◽  
pp. 1022-1027 ◽  
Author(s):  
Darcy L. Green Conaway ◽  
Jonathan R. Enriquez ◽  
Jaime E. Barberena ◽  
Philip G. Jones ◽  
James H. O'Keefe ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Glycemic Control ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Physician Response

scholarly journals Stress-Induced Hyperglycaemia in Non-Diabetic Patients with Acute Coronary Syndrome: From Molecular Mechanisms to New Therapeutic Perspectives

2021 ◽  
Vol 22 (2) ◽  
pp. 775
Author(s):  
Alessandro Bellis ◽  
Ciro Mauro ◽  
Emanuele Barbato ◽  
Antonio Ceriello ◽  
Antonio Cittadini ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Insulin Therapy ◽  
Molecular Mechanisms ◽  
Pancreatic Beta Cell ◽  
Renin Angiotensin System ◽  
Organ Damage ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Improved Outcomes ◽  
Reduction Of Mortality

Stress-induced hyperglycaemia (SIH) at hospital admission for acute coronary syndrome is associated with poor outcome, especially in patients without known diabetes. Nevertheless, insulin treatment in these subjects was not correlated with the reduction of mortality. This is likely due to the fact that SIH in the context of an acute coronary syndrome, compared to that in known diabetes, represents an epiphenomenon of other pathological conditions, such as adrenergic and renin-angiotensin system over-activity, hyperglucagonaemia, increase of circulating free fatty acids and pancreatic beta-cell dysfunction, which are not completely reversed by insulin therapy and so worsen the prognosis. Thus, SIH may be considered not only as a biomarker of organ damage, but also as an indicator of a more complex therapeutic strategy in these subjects. The aim of this review is to analyse the molecular mechanisms by which SIH may favour a worse prognosis in non-diabetic patients with acute coronary syndrome and identify new therapeutic strategies, in addition to insulin therapy, for a more appropriate treatment and improved outcomes.

Hyperglycemia During Acute Coronary Syndrome: A Nurse-Managed Insulin Infusion Protocol for Stricter and Safer Control

2009 ◽  
Vol 8 (3) ◽  
pp. 182-189 ◽  
Author(s):  
Fausto Avanzini ◽  
Giuseppe Marelli ◽  
Walter Donzelli ◽  
Loredana Sorbara ◽  
Enzo Palazzo ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Insulin Infusion ◽  
Tight Glycemic Control ◽  
Diabetic Patients ◽  
Intensive Glucose Control ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
Coronary Care ◽  
Insulin Infusion Protocol ◽  
Infusion Protocol

Background: Diabetic patients with acute coronary syndromes (ACS) might benefit from tight glycemic control by means of insulin infusion. Nurse-implemented insulin infusion protocols (IIP) are available but none validated in patients with ACS admitted to a coronary care unit (CCU). Aims: To assess feasibility, effectiveness and safety of a new nurse-managed IIP (Desio Diabetes Diagram, DDD) for intensive glucose control in patients with suspected ACS and known diabetes or blood glucose (BG) > 200 mg/dL. Methods and results: To reach and maintain a target BG level of 100–139 mg/dL we adopted a nomogram based on the percent changes in the insulin infusion rate according to the current BG value and the percent change from previous BG level. Ninety-one consecutive patients (53 men, mean age 69.7 ± 11.2 years) were treated with DDD IIP. Baseline BG was 202.2 ± 86.8 mg/dL. The median time to achieve the target was 3 h (Q1–Q3 2–5 h). Afterwards target BG levels were maintained for 70.4 ± 15.9% of the time. During 5004 h of insulin infusion BG never fell below 40 mg/dL. Conclusions: The nurse-managed DDD IIP was easily implemented in our CCU and permitted strict and safe glycemic control in hyperglycemic patients with ACS.

scholarly journals Acute Kidney Injury Following Admission with Acute Coronary Syndrome: The Role of Diabetes Mellitus

2021 ◽  
Vol 10 (21) ◽  
pp. 4931
Author(s):  
Arthur Shiyovich ◽  
Keren Skalsky ◽  
Tali Steinmetz ◽  
Tal Ovdat ◽  
Alon Eisen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Kidney Injury ◽  
Acute Coronary Syndrome ◽  
Kidney Injury ◽  
Arterial Disease ◽  
Major Adverse Cardiovascular Events ◽  
Diabetic Patients ◽  
Absolute Increase ◽  
Coronary Syndrome

Purpose: To evaluate the role of diabetes mellitus in the incidence, risk factors, and outcomes of AKI (acute kidney injury) in patients admitted with ACS (acute coronary syndrome). Methods: We performed a comparative evaluation of ACS patients with vs. without DM who developed AKI enrolled in the biennial ACS Israeli Surveys (ACSIS) between 2000 and 2018. AKI was defined as an absolute increase in serum creatinine (³0.5 mg/dL) or above 1.5 mg/dL or new renal replacement therapy upon admission with ACS. Outcomes included 30-day major adverse cardiovascular events (MACE) and 1-year all-cause mortality. Results: The current study included a total of 16,879 patients, median age 64 (IQR 54–74), 77% males, 36% with DM. The incidence of AKI was significantly higher among patients with vs. without DM (8.4% vs. 4.7%, p < 0.001). The rates of 30-day MACE (40.8% vs. 13.4%, p < 0.001) and 1-year mortality (43.7% vs. 10%, p < 0.001) were significantly greater among diabetic patients who developed vs. those who did not develop AKI respectively, yet very similar among patients that developed AKI with vs. without DM (30-day MACE 40.8% vs. 40.3%, p = 0.9 1-year mortality 43.7 vs. 44.8%, p = 0.8, respectively). Multivariate analyses adjusted to potential confounders, showed similar independent predictors of AKI among patients with and without DM, comprising; older age, chronic kidney disease, congestive heart failure, and peripheral arterial disease. Conclusions: Although patients with DM are at much greater risk for AKI when admitted with ACS, the independent predictors of AKI and the worse patient outcomes when AKI occurs, are similar irrespective to DM status.

scholarly journals Understanding ST equivalents on ECG

2021 ◽  
pp. 52-57
Author(s):  
Quoc Bao Tran ◽  
Anh Khoa Phan ◽  
Anh Binh Ho
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Bundle Branch Block ◽  
Cut Point ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Electrocardiogram Ecg

Acute coronary syndrome (ACS) is a syndrome due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies. Even though the detection of a rise and/or fall of cTn values with at least one value above the 99th percentile URL is the key in diagnose of ACS, the role of electrocardiogram (ECG) still plays an important role in ACS simply because of its sensitivity and specificity. In clinical practice, ST-Elevation Myocardial infarction (STEMI) is easy for physicians and cardiologists to identify. STEMI is defined by new ST-elevation at the J-point in the absence of left ventricular hypertrophy and bundle branch block with two contiguous leads with cut-point: ≥ 1mm in all leads other than V2-V3 where the following cut-point apply: ≥ 2mm in men ≥ 40 years; ≥2.5mm in men < 40 years, or ≥ 1.5mm in women regardless of age. 

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