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
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.