Volume : VI, Issue : VIII, August - 2017

Prognostic Implications of Stress Hyperglycemia in Acute Myocardial Infarction A Prospective Observational Comparative Evaluation between Diabetics and Non–Diabetics

Kavya Pingali, Akhilesh Kumar, Markandeya Rao, Sapuri Sreevani

Abstract :

 Background

Stress hyperglycemia occurs in 25–50% of the patients with acute myocardial infarction. It often worsens the prognosis due to associated risk of intrahopsital complications such as mortality, heart failure and cardiogenic shock. There is lack of evidence in Indian patients, particularly taking into consideration contemporary management of acute myocardial infarction. Thus, we aim to assess the incidence and prognostic implication of stress hyperglycemia in diabetic and non–diabetic patients.

Method

This prospective observational study enrolled patients with acute myocardial infarction who presented to the Department of Cardiology, Osmania Government General Hospital, Hyderabad, India from 2011 to 2012. Data regarding random blood sugar, admission blood glucose and HbA1c levels, 2D echo, serial ECGs and oral glucose tolerance test were measured and collected The prognosis was based on resolution of chest pain and ST segment changes, wall motion score index, ejection fraction and in–hospital development of complications like arrhythmias, cardiogenic shock, re–infarction and death.

Results

Normoglycemics (class I) with admission blood glucose (ABG) < 140 were 20, non–diabetics with stress hyperglycemia (class II) with ABG > 140 and HbA1c < 6.6 were 40 and diabetics (class III) with ABG > 140 and HbA1c > 6.6 were 40. Mean blood glucose in class I, II and III was 93.5 mg/dL, 161.0 mg/dL and 262.1 mg/dL respectively. Incidence of stress hyperglycemia among non–diabetics was found to be 40 (66.6%). Mean age of the patients was 48 years, 51 years and 58 years in class I, II and III respectively. In our study males were predominantly affected (75%). Mean HbA1c of class I was 5.32 mmol/mol, class II was 5.37 mmol/mol and class III was 6.77 mmol/mol. The most common site of infarction was anterior wall myocardial infarction. Patients with class II and III class have moderate to severe left ventricular dysfunction with more number in class II. Mean ejection fraction in class I was 60%, class II was 51% and class III was 53%. ST segment reduction was found to be 71.8%, 51.6% and 60.8 % in three classes respectively. Complications were more in class II constituting about 28 (46.6%) and class III constituted 10 (25%. Left ventricular failure was common in class II 12 (30%), while in class III it was 6 (15%). Recurrent angina was commonly found to be 3 (7.5%) in class II.  Mortality was found to be 0 (0%), 8 (20%) and 6 (17.45%) in class I, II and III respectively. Mean of oral glucose tolerance test in class I and II after 2 hours was within normal range, 84.4 and 123.2, while in class III it was 181.7, which is above the normal range.

Conclusion

Stress hyperglycemia is associated with poorer prognosis than chronic diabetes.

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Article: Download PDF   DOI : 10.36106/ijsr  

Cite This Article:

Kavya Pingali, Akhilesh Kumar, Markandeya Rao, Sapuri Sreevani, Prognostic Implications of Stress Hyperglycemia in Acute Myocardial Infarction A Prospective Observational Comparative Evaluation between Diabetics and Non–Diabetics, INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH : VOLUME-6 | ISSUE-8 | AUGUST‾2017

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