The relationship between acute coronary syndrome and stress hyperglycemia.
OBJECTIVE
Hyperglycemia on admission is associated with increased mortality and morbidity in acute coronary syndrome (ACS) irrespective of presence of diabetes mellitus. To the best of our knowledge, no evidence on the relationship between stress hyperglycemia (SH) and the extent of coronary artery disease is found in the literature. Our objective in this study is to assess the relationship of SH with the prognosis of acute coronary syndrome, extent of coronary artery disease (CAD), development of arrhythmia, and major adverse cardiac events.


METHODS
89 patients who were hospitalized in the coronary intensive care unit with diagnosis of ACS between January 2010 and June 2010 were enrolled in the study. The patients were separated into 2 groups as having stress hypergly-cemia or not, according to their blood glucose levels on admission. TIMI and GRACE risk scores were obtained and GENSINI scoring was performed to assess CAD extent for all the patients. Major adverse cardiac events (MACE) (death, MI, re-revascularization, stroke) were recorded for all patients while in the hospital and at 1st and 6th months.


RESULTS
In our study, MACE, GENSINI scores at 6 months and development of in-hospital arrhythmia rates were statistically significantly higher and left ventricular ejection fractions were statistically significantly lower in the group with SH. The association of TIMI, GRACE, GENSINI, New York Heart Association (NYHA) and Killip classifications with blood glucose, fasting blood glucose and HbA1c on admission was confirmed.


CONCLUSIONS
Prognostic course happens to be worse and CAD is more extensive in patients with SH. In addition, blood glucose values may have to be estimated lower compared to the samples in the literature, in order to diagnose SH.
Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University.
H
H
Ayhan
Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University.
T
T
Durmaz
Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University.
T
T
Keleş
Department of Cardiology, Ankara Ataturk Education and Research Hospital.
N A
NA
Bayram
Department of Cardiology, Ankara Ataturk Education and Research Hospital.
E
E
Bilen
Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University.
M
M
Akçay
Department of Endocrinology, Ankara Ataturk Education and Research Hospital.
R
R
Ersoy
Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University.
E
E
Bozkurt
D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications*; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013312:Stress, Physiological / Q000502:physiology*; D019210:Troponin I / Q000097:blood
D001786:Blood Glucose; D002097:C-Reactive Protein; D003402:Creatine Kinase; D006442:Glycated Hemoglobin; D019210:Troponin I