Prevalence of new alterations of glycemia in acute coronary syndrome

Abstract

Introduction: The presence of diabetes is associated with adverse outcomes. The importance of glycosylated hemoglobin in patients with ACS is poorly known. Objectives: To evaluate new cases of glycemic alterations in patients hospitalized for acute coronary syndrome and its relationship with events. Materials and Methods: From January 1, 2014 to December 31, 2014, 92 patients were included with acute coronary syndrome. Glycemia and glycosylated hemoglobin were dosed at admission. According to the definition of the ADA by Glycosylated Hb ≥6.5%, plasma glucose ≥200 mg/dl, fasting plasma glucose ≥126 mg/dl the population was separated into three groups: Group I: non diabetic 41% (44.6), Group II: new DBT 24 (26.1%) and Group III: known DBT: 27 (29.3%). New DBT were considered to be those with glycosylated Hb ≥ 6.5% or blood glucose ≥200 mg/dl. Results: The average age of the population was 64.4 ± 15 years, 19% were women. No baseline differences were observed between groups I, II and III with respect to sex: 63.8% (28 pts) vs 58.3% (14 pts) vs 77.8% (21 pts) p = 0.32; dyslipidemia 39% (16 pts) vs 62% (15 pts) vs 63% (17 pts), p = 0.07; obesity 12.2% (5 pts) 33.3% (9 pts) 12.5% (3 pts), p = 0.06; smoking 43.9% (3 pts) vs 40.7% (11 pts) vs 23.7% (9 pts), p = 0.94; hypothyroidism 7.3% (3 pts) 7.4% (2 pts) 4.2% (1 pts), p = 0.86, respectively, except in HTN: 67.5% (27 pts) vs 67.5% (27 pts) vs 81.5% (22 pts), p = 0.02. The correlation of the composite endpoint of heart failure, cardiogenic shock, re-infarction and death in "non-diabetic patients" with respect to glycemia ≥200 and <200 mg / dl and glycosylated hemoglobin ≥6.5 was 3 vs 13 and with glycosylated Hb < 6.5 it was 8 vs 41 events (p = ns); and in "diabetic patients" with glycemia ≥200 and < 200 mg / dl and glycosylated hemoglobin ≥6.5 it was 9 vs 11 and with glycosylated Hb < 5 it was 0 vs 7 events (p = 0.04). Eight new cases of diabetes were detected by ≥200 mg/dl (8.7%) and 16 by glycosylated Hb ≥6.5% (17.4%) and there were 27 cases of diabetes already diagnosed (29.3%), with 41 cases of patients without diabetes, Kappa coefficient 0.50, p<0.001. Conclusions: Glycosylated hemoglobin >6.5 in non-diabetic subjects and/or glycemia greater than or equal to 200 mg/dl. They identified 17.4% and 8.7% of prevalence of new subjects with metabolic disorders, respectively, and they were associated with a higher prevalence of events in hospital patients for acute coronary syndrome.