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Category: Volume 07 Issue 02 February 2019
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Title: A study of the relation of HbA1c levels in acute coronary syndrome and its complications

Authors: Ashraf B.K., Jacob K Jacob, Jilse George, Suma Samuel, Bhagyanath T

 DOI: https://dx.doi.org/10.18535/jmscr/v7i2.62

Abstract

Introduction: The risk of coronary artery disease (CAD) is higher in diabetic patients. In Indians, CAD occurs one decade earlier than the west. HbA1C is an easy marker of long term glucose regulation as it provides a good reflection of plasma glucose concentrations over 8 – 12 weeks .Abnormal glucose metabolism is associated with increased mortality and complications following ACS. This study was conducted in ICU of Govt. Medical College, Ernakulam among patients admitted following ACS using HbA1C in blood and observing the complications for first week.

Materials and Methods: 188 patients admitted with Acute Coronary Syndrome in Government Medical college, Ernakulam between January 2016 and December 2016, were evaluated clinically and with the investigatory facilities available at this institution. Their HbA1C levels were measured at the laboratory of Government Medical college Ernakulam. The clinical features and investigation results were noted. HbA1C levels in UNSTABLE ANGINA, NSTEMI, STEMI, and in complications like arrhythmias, cardiac failure, cardiogenic shock also were studied and the data analysed.

Results and Discussion: Out of 188 patients, 63.85% were males and 36.2% females .Mean age was 61.5± 9.5. 42. 6% had past H/O diabetes and 51.1% had past h/o CAD. 66% had HbA1C less than 6.5 and 11.2% had HbA1C greater than 8.5%;22.9% had HbA1c level between 6.5% and 8.5%.Out of 188 patients, 63.3% had NSTEMI , 24.5% had STEMI and 12.2% had UNSTABLE ANGINA. Cardiac failure as a complication in 48 hrs, showed an increase as 17.7%,53.5%,66.7% withincrease in HbA1C levels,<6.5,6.5-8.5,>8.5 respectively. Cardiac failureas a complication after 3-7 days also showed an increase as 16.1%, 353.5% 61.9%% with increase in HbA1Clevels,<6.5,6.5-8.5,>8.5respectively.

Conclusions: Acute coronary syndrome patients admitted in ICU of Government medical college Ernakulam had optimum long term glycemic control(HbA1C<6.5)in 66% of patients. NSTEMI is the most common acute cardiac state among ACS in this study which however not increased with increasing levels of HbA1c .Complications like cardiac failure in first 48 hrs and within 1 week was significantly higher in patients with higher HbA1C.

Keywords: Glycosylated haemoglobin, Acute coronary syndrome, STEMI, NSTEMI, Unstable angina, cardiac complications.

References

  1. Mulnier HE, Seaman HE, Raleigh VS, Soedamah , Muthu SS. Mortality in people with type 2 diabetes in the UK. Diabet Med 2006;23:516–521.
  2. Husband DJ, Alberti KG, Stress hyperglycaemia during acute Myocardial infarction: An indicator of pre-existing diabetes? Lancet, 1983; 2: 179-81
  3. Brownlee M. Advanced glysosylation in diabetes and aging. Ann Rev Med 1988; 46: 223-4.
  4. Haffner SM, Lehto S, Ronnemaa T, Pyorala K. Mortality from coronary       heart disease in subjects with type 2 diabetes and in non diabetic subjects with and without prior myocardial infarction.  N Engl J Med 1998;339:229-34.
  5. HYPERGLYCEMIA IN ACS Management; NICE Guidelines.; nice.org.uk/guidance/cq130
  6. McCune C, Maynard S, McClements B Lindsay HbA1c for Diabetes Screening in Acute Coronary Syndrome:time for a reappraisal of the      guidelines?  Ulster Med J 2015;84(3):154-156
  7. MEDICINE UPDATE 2010;Vol 20
  8. Kishore P, Kim SH, Crandall JP. Glycemic control and cardiovascular disease: what’s a doctor to do? Curr Diab Rep    2012; 12: 255-264 [PMID: 22467273 DOI: 10.1007/s11892-012-0268-5] 
  9. Mohammed K. Ali, K.M. Venkat Narayan& Nikhil  Tandon Diabetes & coronary heart disease: Current   perspectives  Indian J   MedRes 132, November 2010, pp 584-597  .
  10. Mahmut Cakmak MD, Nazmiye Cakmak MD, Sebnem Cetemen  MD  The value of admission glycosylated hemoglobin level  in patients with acute myocardial infarction  Can J Cardiol   2008;24(5):375-378.
  11. Sheetal D Vora,et al A Study of Glycosylated Hemoglobinin acute coronarysyndrome. National journal   of community medicine vol 7 issue2 feb 2016
  12. Nayak Rashmi and Chauhan Vinay Singh. Glycosylated Haemoglobin as adiagnostic  marker of diabetes  mellitus in acute myocardial  infarction  and  correlation with diaterypattern, international research journal of medical sciences vol3(6)1-4 june2015
  13. Chiara Lazzeri, Serafina Valente, Marco ChiostriClinical significance of glycated  hemoglobin in the acute phase of ST  elevation myocardial infarctionWorld J  Cardiol2014 April 26; 6(4): 140-147
  14. Viswanathan Mohan et al- ‘’epidemiology of cardiovascular disease in type 2diabetes :theindian Scenario {’’journal of Diabetes Science and Technology’  ’vol 4   issue1 jan 2010 }
  15. Amitani M Sultanqaboos University Med J.Aug 201 3vol  13ISS 3 ,PP 368-370   E Pub25 Jun 13    Sub 21 May 13,
  16. N. Dubey, Kaustubh Mundada, A Arya. Correlation of HbA1c with mortality and severity in acute coronary syndrome. International Journal  of Contemporary Medical Research 2016;3(8):2244-2247.
  17. Vinita Elizabeth Mani*, Mary John**, Rajneesh Calton Impact of HbA1c on Acute Cardiac States JAPI • JUNE 2011 • VOL. 59
  18. Y. Ramesh Naidu, Y. Sharmila, Y.Nischal, V. Srinivas, V.  Satyaprasad. “Study of HbA1c levels in Acute Coronary Syndrome”. Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 77, September 24; Page: 13274-13278, DOI: 10.14260/jemds/2015/1909

Corresponding Author

Jacob K Jacob

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