GLYCEMIC STATUS AND SHORT TERM OUTCOME IN PATIENTS WITH DIABETES MELLITUS ADMITTED WITH ACUTE MACROVASCULAR COMPLICATION IN A TERTIARY CARE HOSPITAL IN INDIA

2021 ◽  
pp. 31-33
Author(s):  
Soumyajit Mukherjee ◽  
Prabir Kumar Kundu ◽  
Indira Maisnam ◽  
Apurba Kumar Mukherjee
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Cerebrovascular Accident ◽  
Limb Ischemia ◽  
Diabetic Patients ◽  
Acute Limb Ischemia ◽  
Care Hospital ◽  
Medical College ◽  
Coronary Syndrome ◽  
Hospitalized Patient

Introduction: Diabetes is a global endemic with rapidly increasing prevalence in both developing and developed countries. Over the past two decades the prevalence of diabetes has risen from an estimated 30 million cases in 1985 to 415 million in 2017. Aims & objectives: To study HbA1c and other biochemical & clinical parameters of acute ischemic cerebrovascular accident, acute coronary syndrome and acute limb ischemia in diabetic patients. Specific objectives: · To estimate 72 hrs mortality in hospitalized patient with diabetes mellitus with acute ischemic cerebrovascular accident. · To estimate 72 hrs mortality in hospitalized patient with diabetes mellitus with acute coronary syndrome · To estimate 72 hrs mortality in hospitalized patient with diabetes mellitus with acute limb ischemia · To study correlation between HbA1C and 72 hours mortality of patients with acute macrovascular events among diabetics. Materials & methods: Department of general medicine, R.G.Kar Medical College and Hospital.Cases were selected from medicine inpatients department of R.G.Kar Medical College and Hospital. 1st July, 2018-30th June 2019. This is an observational prospective study Conclusion: In our study we found that higher HbA1C is associated with statistically signicant increase in 72 hour mortality in patients with acute ischemic stroke and trend of increased mortality (though not statistically signicant) in patients (p=0.0002 & 0.056 respectively)

scholarly journals Caracterização do perfil e complicações intra-hospitalares dos pacientes submetidos ao cateterismo cardíaco em um hospital terciário

2017 ◽  
Vol 27 (1) ◽  
pp. 24806
Author(s):  
Débora Ferreira Braga ◽  
Gustavo Paes Silvano ◽  
Thainá Ferreira Furtado Pereira ◽  
Fabiana Schuelter-Trevisol ◽  
Daisson José Trevisol
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Hospital Stay ◽  
Cardiac Catheterization ◽  
Tertiary Care ◽  
Care Hospital ◽  
Puncture Site ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
Triple Vessel Disease

DOI: 10.15448/1980-6108.2017.1.24806 Aims: To evaluate the profile of patients undergoing cardiac catheterization and in-hospital complications associated with the procedure.Methods: Cross-sectional analysis of baseline data of a retrospective cohort study conducted in a tertiary care hospital in southern Brazil between 2007 and 2013. The study included patients undergoing diagnostic or therapeutic cardiac catheterization. The data were extracted from electronic medical records using a standardized form and stored in a database for further analysis.Results: Out of 994 assessed patients, 584 (58.8%) were male. The mean age was 61.4 years. Hypertension was the most prevalent risk factor, followed by dyslipidemia and diabetes mellitus. Regarding clinical presentation, 550 (55.3%) patients had acute coronary syndrome, 402 (40.4%) had stable angina, and 42 (4.2%) were asymptomatic. Cineangiography was normal in 152 (15.3%) patients and abnormal in 842 (84.7%). Of these, 251 (29.8%)  had single vessel disease, 190 (22.6%) had double vessel disease, and 401 (47.6%) had triple vessel disease. The overall incidence of complications was 15.6%, and 1% of the patients suffered some kind of major event (death during the procedure and neurological complications during their hospital stay). Other complications included acute kidney injury (1.4%) and local vascular complications (13.2%), mainly hematoma at the puncture site. Fifty (5%) patients died during the hospital stay, 46 (92%) of them from cardiac causes. Conclusions: The patients undergoing cardiac catheterization were predominantly male, with mean age of 61.4 years. The most frequent risk factors for cardiovascular disease included hypertension, dyslipidemia, and diabetes mellitus. Most of the patients had triple vessel disease. The main indication for the procedure was acute coronary syndrome. The overall incidence of complications was 15.6% with predominance of hematoma at the puncture site.

P3606Impact of diabetes mellitus on the selection of antiplatelet treatment and medium-term prognosis after acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Nunez Martinez ◽  
N V-Ibarra ◽  
F Marin Ortuno ◽  
V Pernias Escrig ◽  
M Sandin Rollan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Coronary Disease ◽  
Cardiovascular Events ◽  
Diabetic Patients ◽  
Medium Term ◽  
Coronary Syndrome ◽  
Diabetic Population ◽  
One Year

Abstract Introduction Patients with diabetes mellitus (DM) have a higher atherothrombotic risk and higher rates of recurrent ischemic events compared with the non-diabetic population. Although current antiplatelet therapy strategies have been shown to be successful in improving outcomes in acute coronary syndrome (ACS), patients with DM continue to experience high rates of adverse cardiovascular events. Today, it is known that diabetic patients are characterized by a deregulation in different intracellular signaling pathways, which leads to an inadequate or suboptimal response to antiplatelets agents. The purpose of this study is to analyze the different therapeutic strategies, the use of new antiplatelet drugs and medium-term prognosis in diabetic patients compared with non-diabetic patients who have suffered an ACS. Methods It is an observational, prospective and multicenter registry of patients with ACS. The objective is to analyze the differences in the management of DM patients vs non-DM patients in the acute phase and their evolution during the first year after coronary event. Antiplatelet therapy administered will be evaluated, type of coronary injury and treatment performed, major adverse events as well as cardiovascular complications and mortality at one year of follow-up. Results Of a total of 1717 patients, 38% were diabetic. The diabetic population was older, with a higher prevalence of cardiovascular risk factors and higher rate of previous cardiovascular events (cerebrovascular, peripheral arterial disease and coronary disease). Patients with DM received less new antiplatelets drugs at admission (15.5% DM vs 26.5% non DM, p<0.001) and less in-hospital switch to new antiplatelet agents was performed. They were subjected to a lower number of catheterizations and at the time of revascularization, the drug-eluting stent was of choice. During admission, they developed more complications, both ischemic (refractory angina, reinfarction or CVA) and hemorrhagic. Following one year, DM had higher major cardiovascular events (MACE) and higher mortality (7.72% vs 5.14%, p=0.0039). Non-coronary revascularization, renal failure, and reduced ejection fraction were predictive variables of death in diabetic population. Treatment with new antiplatelet drugs was associated with a statistically significant decrease in total mortality an MACE without differences in major bleeding. Conclusion More than a third of patients with ACS are diabetic. These patients present with more severe coronary disease associating a greater number of cardiovascular events and a higher mortality rate after one year of ACS. However, despite this, they undergo less invasive tests and they were undertreated with the new antiplatelets therapies. Acknowledgement/Funding SEC

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.

scholarly journals HOSPITAL BASED STUDY TO DETERMINE THE PREVALENCE OF GLAUCOMA IN TYPE 2 DIABETIC PATIENTS.

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Archana Kumari ◽  
Sony Sinha
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Tertiary Care ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Type 2 Diabetic Patients ◽  
Medical College ◽  
Department Of Ophthalmology ◽  
Type 2 Diabetic

Aim: to analyze the prevalence of glaucoma in type 2 diabetic patients. Materials and Methods: present observational study was undertaken in the Department of Ophthalmology, Patna Medical College and Hospital, Patna, Bihar, India for the period of one year. Total 100 patients of type 2 Diabetes Mellitus were included and detailed history was obtained. Results: Out of 100 diabetic patients 8 (8%) of them had glaucoma. Out of 8 diabetic patients with glaucoma 75.0% were male. The mean age reported was 58.16±4.81. Conclusion: This study highlights the prevalence and the demographic characteristics of glaucoma among diabetes mellitus patients in a tertiary care hospital of Bihar. Since, no such study has been done before in this region. Keywords: Type 2 diabetes, Glaucoma, Bihar

Ticagrelor versus prasugrel in diabetic patients with an acute coronary syndrome

2014 ◽  
Vol 111 (02) ◽  
pp. 273-278 ◽  
Author(s):  
Marc Laine ◽  
Corinne Frere ◽  
Richard Toesca ◽  
Julie Berbis ◽  
Pierre Barnay ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Platelet Reactivity ◽  
Statistical Significance ◽  
Randomised Trial ◽  
Diabetic Patients ◽  
Loading Dose ◽  
Open Label ◽  
Coronary Syndrome ◽  
Patients With Diabetes

SummaryOptimal P2Y12 receptor blockade is critical to prevent ischaemic recurrence in patients undergoing percutaneous coronary intervention (PCI). We aimed to compare the level of platelet reactivity (PR) inhibition achieved by prasugrel and ticagrelor loading dose (LD) in diabetic acute coronary syndrome (ACS) patients undergoing PCI. We performed a single-center prospective open-label randomised trial. Patients with diabetes mellitus undergoing PCI for an ACS were randomised to receive prasugrel 60 mg or ticagrelor 180 mg. The primary endpoint of the study was the level of platelet reactivity (PR) assessed between 6 and 18 hours post-LD using the VASP index. We randomised 100 diabetic patients undergoing PCI for an ACS. No difference was observed in baseline characteristics between the two groups. In particular, the rate of patient receiving insulin therapy was identical (25 vs 28.6%; p =0.7). Ticagrelor achieved a significantly lower PR compared to prasugrel loading dose (17.3 ± 14.2 vs 27.7 ± 23.3%; p=0.009). In addition the rate of high on-treatment platelet reactivity, defined by a VASP ≥50%, tend to be lower in the ticagrelor group although the difference did not reach statistical significance (6 vs 16%; p=0.2). The rate of low on treatment PR was identical (60 vs 54%; p=0.8). The present study demonstrates that ticagrelor LD is superior to prasugrel LD to reduce PR in ACS patients with diabetes mellitus. Whether the higher potency of ticagrelor could translate into a clinical benefit should be investigated.

scholarly journals Increased Atherothrombotic Burden in Patients with Diabetes Mellitus and Acute Coronary Syndrome: A Review of Antiplatelet Therapy

2012 ◽  
Vol 2012 ◽  
pp. 1-18 ◽  
Author(s):  
Karthik Balasubramaniam ◽  
Girish N. Viswanathan ◽  
Sally M. Marshall ◽  
Azfar G. Zaman
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Platelet Inhibition ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Patients With Diabetes ◽  
Thrombotic Complications ◽  
Underlying Pathophysiology ◽  
Ischemic Events

Patients with diabetes mellitus presenting with acute coronary syndrome have a higher risk of cardiovascular complications and recurrent ischemic events when compared to nondiabetic counterparts. Different mechanisms including endothelial dysfunction, platelet hyperactivity, and abnormalities in coagulation and fibrinolysis have been implicated for this increased atherothrombotic risk. Platelets play an important role in atherogenesis and its thrombotic complications in diabetic patients with acute coronary syndrome. Hence, potent platelet inhibition is of paramount importance in order to optimise outcomes of diabetic patients with acute coronary syndrome. The aim of this paper is to provide an overview of the increased thrombotic burden in diabetes and acute coronary syndrome, the underlying pathophysiology focussing on endothelial and platelet abnormalities, currently available antiplatelet therapies, their benefits and limitations in diabetic patients, and to describe potential future therapeutic strategies to overcome these limitations.

scholarly journals Predictive value of the N-terminal prohormone of brain natriuretic peptide in the long-term prognosis of ventricular arrhythmia in diabetic patients with acute coronary syndrome of young and middle age

2020 ◽  
Vol 43 (4) ◽  
pp. 522-538
Author(s):  
Zheming Wang ◽  
◽  
Elena A. Asafieva ◽  
Tatiana I. Makeeva ◽  
◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Ventricular Arrhythmia ◽  
Natriuretic Peptide ◽  
Middle Age ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Patients With Diabetes ◽  
Long Term Prognosis

The article investigates the prognostic value of pro-B-type N-terminal natriuretic peptide (NTproBNP) in connection with ventricular extrasystoles (VES) in a population of patients with diabetes mellitus with acute coronary syndrome (ACS) after successful coronary reperfusion by percutaneous coronary intervention (PCI). Patients with ACS were examined by defining biomarkers and performing echocardiography (EchoCG) on the first day of ACS after PCI with stenting of the infarction-related coronary artery, and Holter monitoring of electrocardiography (HM-ECG) on the second day after PCI; 12 months later, EchoCG, HM-ECG and NT-proBNP determination were repeated. It was found that the incidence of VES in the long-term prognosis among ACS patients with diabetes of young and middle age was more frequent than in patients without diabetes. A positive correlation was found between the NTproBNP level and ventricular arrhythmia in ACS patients with diabetes mellitus. It has been proven that a high level of NT-proBNP on the first day in patients with ACS after PCI as an independent indicator of risk to development of VES in long-term prognosis.

scholarly journals Insulin Resistance and Contrainsular Response in Type 2 Diabetes Mellitus Patients with Acute Coronary Syndrome

2020 ◽  
Vol 8 (B) ◽  
pp. 943-948
Author(s):  
Dinara Sheryazdanova ◽  
Yelena M. Laryushina ◽  
Larissa Muravlyova ◽  
Lyudmila G. Turgunova ◽  
Assel R. Alina ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Acute Coronary Syndrome ◽  
Logistic Regression ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Diabetic Patients ◽  
Positive Correlation ◽  
Coronary Syndrome

BACKGROUND: The number of patients with diabetes mellitus (DM) is progressively increasing all over the world. Over the past three decades, the global burden of diabetes has increased from 30 million in 1985 to 382 million in 2015, and current trends indicate that the prevalence of diabetes grows progressively. The phenomenon of insulin resistance established in the majority of type 2 DM (T2DM) patients. T2DM is associated with β-cell deficiency, α-cell resistance to insulin, and reduced effects of incretin. However, the role of insulin and glucagon in the process of cardiovascular complications in diabetic patients is a matter of debate. AIM: Our study aims to estimate insulin resistance and the contrainsular response in patients with T2DM and acute coronary syndrome (ACS). METHODS: The 104 T2DM patients aged 18–70 years participated in the observational study carried out in the Karaganda regional cardiosurgery hospital and ambulatory. The first group included 37 patients hospitalized for ACS in the first 24 h of admission. The second group included 67 patients without ACS. Determination of insulin resistance and contrainsular response was provided using a multiplex immunological assay with XMap technology on Bioplex 3D. RESULTS: During the research, we have discovered a decreased level of glucagon and increased homeostasis model assessment of insulin resistance (HOMA-IR) in patients with T2DM diabetes and ACS. Evaluation of traditional correlation interactions of HOMA-IR and indicators of carbohydrate metabolism showed a positive correlation with fasting plasma glucose in both study groups (Group 1: R = 0.47, p = 0.003; Group 2: R = 0.41, p = 0.024). Glucagon-like peptide (GLP)-1 has a weak positive correlation with HOMA-IR only in the first group (R = 0.32, p = 0.006). Increased insulin resistance was associated with high GLP-1 levels and low glucagon. The logistic regression model established that an increased HOMA-IR index rises the chance of ACS by 10.6% (OR = 1.106 [95% CI 1.105–1.206], p = 0,021). The logistic regression model, reflecting the relation between glucagon and ACS, shows that increased glucagon reduces the ACS odds (OR = 0.989 [95% CI 0.979–0.999], p = 0.026). The adjusted regression model showed no significant influence of early presented factors on the probability of ACS. CONCLUSION: There is a trend toward elevated HOMA-IR insulin resistance index and decreased level of glucagon in diabetic 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.

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