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Abstract

ABSTRACT: BACKGROUND: In nondiabetic patients, elevated admission glucose level is a strong predictor of short-term adverse outcome in patients with acute coronary syndrome. Admission glucose may be affected by meals, the circadian cycle, and also the stress response. Glycated hemoglobin A1c is a convenient marker of long-term glucose regulation. However, the prognostic value of diabetic control assessed by HbA1c level in patients with acute coronary syndrome (ACS) is still undefined. OBJECTIVE: To determine the association between (admission glucose and HbA1c) and short term outcome in patients not known to be diabetics presented with ACS. PATIENTS AND METHODS: This observational study included 50 consecutive patients without known diabetes mellitus admitted to the coronary care unit with ACS. Patients were sub-divided into three groups: patients with unstable angina (UA, n = 10), those with ST segment elevation myocardial Infarction (STEMI, n = 18) and those with non ST segment elevation myocardial infarction (NSTEMI, n = 22). Patients were stratified according to their HbA1c into three groups: Group 1: 8.5 (16, 32%). Both glucose and HbA1c were measured on admission. The diagnosis of ‘‘undiagnosed DM’’ was made if patients presented with fasting glucose >7.0 mmol/L or random glucose >11.1 mmol/L together with an admission HbA1c >6.5% according to the latest ADA recommendations. Main outcome measure was left ventricular (LV) systolic function which was assessed by ejection fraction (EF); and the set point was 50%. Data were analyzed separately using multiple regression analysis. RESULTS: The mean age of patients was 60.6 ± 6.33 years and 74% were males. Of total, 42% were smokers, 68% were hypertensive, 48% had hyperlipidemia and BMI ≥ 30 in 22%. Eighteen percent of patients were diagnosed as new cases of DM. Mean admission glucose was higher in patients with EF< 50% compared to those with EF> 50% with statistically significant difference (P< 0.05). There was a linear correlation between EF% and HbA1c in all types of presentation. 95.5% of patients in group 2 and 100% of patients in group 3 showed EF

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