A Prospective study on the correlation between admission day glycemic status and in-hospital outcome of acute coronary syndrome in diabetic and non diabetic patients

Our study was a prospective study connducted to analyse the assosciation between the admission RBS and HbA1c values with the outcome of ACS patients during the hospitalization period.Study was done in 101 patients which included both diabetics & non-diabetics. Of the total patients 53 were type 2 diabetes mellitus. Mean blood sugar among diabetics was 260.65mg/dl and non diabetics 178.49 mg/dl and mean HbA1c among diabetics was 7.54 and non diabetics 6.15. The difference was statistically significant indicating the diabetic population had both high RBS and poor control. 46% had ST elevation Ml, 35% non ST elevation Ml and 19 had unstable angina. Adverse cardiac events such as acute left ventricular failure, ventricular arrhythmias and cardiogenic shock were found in 44 patients. During discharge 87 had recovered satisfactorily, 8 had complications such as residual ventricular dysfunction, AV block, ventricular septal rupture, and mitral regurgitation. Six patients had died due to left ventricular failure and ventricular arrhythmias. There were no age and sex preponderance with adverse cardiac events, and the duration of diabetes, while these patients had longer hospital stay. The mean admission RBS were significantly high in patients with adverse cardiac events while HbA1c was not. Also when patients presented with admission RBS ≥140mg% had significantly higher adverse cardiac events especially in non diabetic patients. There was no statistical significant association between HbA1c and adverse cardiac events in diabetic as well as non diabetic patients. Both HbA1c and admission glucose may have relation with adverse outcome. However, our results suggest that increased admission glucose is more important. The less clear association between HbA1c and prognosis in our analysis could be due to a limited number of patients with a relatively short follow-up in our study. RECOMMENDATIONS : Blood sugar control among diabetics is necessary to prevent ACS. Blood sugar control in ACS patients is essential to improve its outcome whether the patient had diabetes or not. Long term follow up study is required to evaluate the effect of uncontrolled diabetes following ACS. From this study it is clear that higher admission blood sugar value in ACS is a powerful predictor of increased incidence of in-hospital adverse events, especially in subjects without prior history of diabetes. Also it is evident that hyperglycemia is very frequent in the setting of acute coronary syndrome and mostly this is left untreated. Hence acute hyperglycemia in ACS needs early detection and prompt management should be carried out inorder to have a better outcome