A comparative study of the severity and short-term complications of acute coronary syndrome (ACS) in diabetics and non-diabetics admitted to the intensive coronary care unit (ICCU) in a tertiary care hospital of western Maharashtra

 

 

Abstract              Background: High admission blood glucose levels after acute coronary events are common and are associated with an increased risk of deaths. Elevated admission glucose levels in non-diabetic patients with AMI are independently associated with larger infarct sizes and a higher long term mortality rates when compared with patients with normal glucose levels. Diabetes is considered as a high risk factor for ‘vascular diseases’. A significant proportion of patients with acute coronary syndrome have hyperglycemia, a significant risk factor for adverse outcomes in both diabetic and non-diabetic patients. The present study was undertaken to find out the correlation between HbA1c levels and the severity and complications in diabetic and non-diabetic patients. Methodology: 100 patients who came with Acute Coronary Syndrome who fulfilled inclusion / exclusion criteria, will be enrolled for the study. All patients underwent routine investigations. Group A had diabetic patients with ACS and group B had nondiabetic patients. Results: There were 72% males and 28% females in group A, while 70% males and 30% females in group B. The mean age for Acute Coronary Syndrome in diabetic patients was 58.33 years and non-diabetics it was 58.58 years. There was significant difference between the HbA1C, Random BSL and CPKMB values of the two groups (p < 0.01). There was a highly significant association between Troponin-I in Diabetes and non-diabetes cases. (p = 0.0065). There was a highly significant difference between proportion of complications Arrhythmias, Cardiac Arrest, and Shock when diabetes group compared with Non-diabetes group (i.e. (p<0.01) and no significant between proportion of complications Heart failure, Accelerated Hypertension, and Diabetic Ketoacidosis (p>0.05). Conclusion: Glycosylated haemoglobin (HbA1c) is a significant and early predisposing factor for developing acute sever coronary events. Heart Failures, Cardiogenic Shock and Arrhythmias are common complications seen in ACS with HbA1C >7 % in diabetics and non-diabetics. Admission Hyperglycemia is a poor prognostic marker than Glycosylated Haemoglobin in ACS.

Key Word: acute coronary syndrome.