Abstract
Background: Diabetes is a major causative risk factor for the development of ACS & the adverse outcome after ACS. ‘Stress hyperglycaemia’ has been defined in different ways by various studies. Transient hyperglycaemia has been recognized as a noticeable feature in ACS and is related to stress (Lakhdar et al., 1984).[1] Glycosylated haemoglobin is thus useful to differentiate between stress hyperglycaemia diabetes mellitus. Glycosylated haemoglobin has more sensitivity and specificity for diagnosing diabetes in acute myocardial infarction patients, than admission hyperglycaemia.
Methods: All the patients presenting with Acute coronary syndrome and with no previous history of diabetes admitted in Department of General Medicine during the study period from September 2017 to August 2019 were included in the study.
Results: Among 100 patients, males were predominant (70%). 38% patients were in the age group of 51-60 years of age (max). Most common presenting complaint of patients was chest pain (84%) followed by dyspnoea (17%), lower limbedema (16%), and palpitations (9%). 58 % patients had HbA1c > 7 % which was considered as raised 42 % had HbA1c within normal limits. 58 % patients had previously unrecognized diabetes mellitus that came to light after HbA1c estimation. This would have been otherwise interpreted as stress hyperglycaemia. Thus, HbA1c estimation permits prompt and precise identification of previously undiagnosed diabetes mellitus.
Conclusion: HbA1c estimation is a useful, simple, easy and quick method for early and quick method for accurate measurement and interpretation of hyperglycaemia following acute myocardial infarction
Keywords: Acute coronary syndrome, HbA1c, Non diabetics.
References
- Lakhdar A, Stromberg P, McAlpine SG. Prognostic importance of hyperglycemia induced by stress after acute myocardial infarction. British medical journal (Clinical research ed.). 1984 Jan 28;288(6413):288.
- Ceriello A. Acute hyperglycemia: a ‘new’ risk factor during myocardial infarction. European Heart Journal. 2004 Nov 30;26(4):328-31.
- Soler NG, Frank S. Value of glycosylated hemoglobin measurements after acute myocardial infarction. Jama. 1981 Oct 9;246(15):1690-3.
- Oswald GA, Yudkin JS. Hyperglycaemia following acute myocardial infarction: the contribution of undiagnosed diabetes. Diabetic medicine. 1987 Jan 2;4(1):68-70.
- Gokhroo RK, Sethi JP, Bharadwaj B, Mitta SR. Glycosylated hemoglobin in acute myocardial infarction. The Journal of the Association of Physicians of India. 1985 Jul;33(7):478.
- Naseem A, Moin S. Comparison of diabetics and non-diabetics presenting with acute myocardial infarction. JCPSP. Journal of the College of Physicians and Surgeons Pakistan. 2002;12(6):356-60.
- Maity AK, Sen AK, Chhetri MK. Profile of coronary problems in myocardial infarction in diabetics and non-diabetics. Journal of the Indian Medical Association. 1986 Feb;84(2):37.
- Bradley RF, Schonfeld A. Diminished pain in diabetic patients with acute myocardial infarction. Geriatrics (Basel, Switzerland). 1962 May;17:322-6.
- MADSEN JK, HAUNSØE S, HELQUIST S, HOMMEL E, MALTHE I, PEDERSEN NT, SENGELØV H, RØNNOW‐JESSEN DO, TELMER S, PARVING HH. Prevalence of hyperglycaemia and undiagnosed diabetes mellitus in patients with acute myocardial infarction. Acta medica Scandinavica. 1986 Jan 12;220(4):329-32.
- Lohitashwa SB. Glycosylated Haemoglobin As A Diagnostic Marker Of Diabetes Mellitus In Acute Myocardial Infarction (Doctoral dissertation).
- Stranders I, Diamant M, van Gelder RE, Spruijt HJ, Twisk JW, Heine RJ, Visser FC. Admission blood glucose level as risk indicator of death after myocardial infarction in patients with and without diabetes mellitus. Archives of internal medicine. 2004 May 10;164(9):982-8.
- Mak KH, Mah PK, Tey BH, Sin FL, Chia G. Fasting blood sugar level: a determinant for in-hospital outcome in patients with first myocardial infarction and without glucose intolerance. Annals of the Academy of Medicine, Singapore. 1993 May;22(3):291-5.
- Bertoni AG, Hundley WG, Massing MW, Bonds DE, Burke GL, Goff DC. Heart failure prevalence, incidence, and mortality in the elderly with diabetes. Diabetes care. 2004 Mar 1;27(3):699-703.
- Lu WQ, Resnick HE, Jablonski KA, Jain AK, Jones KL, Robbins DC, Howard BV. Effects of glycaemic control on cardiovascular disease in diabetic American Indians: the Strong Heart Study. Diabetic medicine. 2004 Apr;21(4):311-7.
- Cai L, Li W, Wang G, Guo L, Jiang Y, Kang YJ. Hyperglycemia-induced apoptosis in mouse myocardium: mitochondrial cytochrome C–mediated caspase-3 activation pathway. Diabetes. 2002 Jun 1;51(6):1938-48.
- Khaw KT, Wareham N, Bingham S, Luben R, Welch A, Day N. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Annals of internal medicine. 2004 Sep 21;141(6):413-20.
- Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati FL, Powe NR, Golden SH. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Annals of internal medicine. 2004 Sep 21;141(6):421-31.
- Sanjuán R, Núñez J, Blasco ML, Miñana G, Martínez-Maicas H, Carbonell N, Palau P, Bodí V, Sanchis J. Prognostic implications of stress hyperglycemia in acute ST elevation myocardial infarction. Prospective observational study. Revista Española de Cardiología (English Edition). 2011 Mar 1;64(3):201-7.
- Krishna K, Pathan S, Hiremath S. In-hospital outcome of acute myocardial infarction and its correlation with plasma sugar levels. Journal of Indian College of Cardiology. 2012 Jun 1;2(2):59-63.
Corresponding Author
Dr Kunal Ostwal
Department of General Medicine Dr. D. Y. Patil Medical College, hospital and research centre, Pimpri, Pune
DOI: https://dx.doi.org/10.18535/jmscr/v8i4.67
