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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
42
VOLUME 17 NUMBER 2 • NOVEMBER 2020
Prognostic value of admission hyperglycaemia in black
Africans with acute coronary syndromes: a cross-sectional
study
Hermann Yao, Arnaud Ekou, Thierry Niamkey, Camille Touré, Charles Guenancia,
Isabelle Kouamé, Christelle Gbassi, Christophe Konin, Roland N’Guetta
Correspondence to: Hermann Yao
Abidjan Heart Institute, Abidjan, Ivory Coast
e-mail:
hermannyao@gmail.comArnaud Ekou, Thierry Niamkey, Camille Touré, Isabelle Kouamé,
Christelle Gbassi, Christophe Konin, Roland N’Guetta
Abidjan Heart Institute, Abidjan, Ivory Coast
Charles Guenancia
Cardiology Department, Dijon University Teaching Hospital, Dijon, France
Previously published in
Cardiovasc J Afr
2020;
31
: 319–324
S Afr J Diabetes Vasc Dis
2020;
17
: 42–47
Abstract
Aim:
The aim of the study was to determine the relationship
between acute hyperglycaemia and in-hospital mortality in
black Africans with acute coronary syndromes (ACS).
Methods:
From January 2002 to December 2017, 1 168
patients aged ≥ 18 years old, including 332 patients with
diabetes (28.4%), consecutively presented to the intensive
care unit of the Abidjan Heart Institute for ACS. Baseline data
and outcomes were compared in patients with and without
hyperglycaemia at admission (> 140 mg/dl; 7.8 mmol/l).
Predictors for death were determined by multivariate logistic
regression.
Results:
The prevalence of admission hyperglycaemia was
40.6%. It was higher in patients with diabetes (55.3%).
In multivariate logistic regression, acute hyperglycaemia
(hazard ratio = 2.33; 1.44–3.77;
p
< 0.001), heart failure
(HR = 2.22; 1.38–3.56;
p
= 0.001), reduced left ventricular
ejection fraction (HR = 6.41; 3.72–11.03;
p
< 0.001, sustained
ventricular tachycardia or ventricular fibrillation (HR = 3.43;
1.37–8.62;
p
= 0.008) and cardiogenic shock (HR = 8.82;
4.38–17.76;
p
< 0.001) were predictive factors associated
with in-hospital death. In sub-group analysis according to
the history of diabetes, hyperglycaemia at admission was a
predictor for death only in patients without diabetes (HR =
3.12; 1.72–5.68;
p
< 0.001).
Conclusion:
In ACS patients and particularly those without a
history of diabetes, admission acute hyperglycaemia was a
potentially threatening condition. Appropriatemanagement,
follow up and screening for glucose metabolism disorders
should be implemented in these patients.
Keywords:
hyperglycaemia, diabetes, acute coronary syndrome,
sub-Saharan Africa
Studies in the West have shown that elevation of blood glucose
is a common condition during the early phase of acute coronary
syndrome (ACS), even in the absence of a history of diabetes
mellitus (DM).
1-3
There is no uniform definition at present, but the
140 mg/dl (7.8 mmol/l) threshold has often been considered.
4
The
prevalence of acute hyperglycaemia > 140 mg/dl ranged from 39
to 58%.
1,2,5
In addition to established prognostic factors (left ventricular
systolic dysfunction, heart failure, ventricular arrhythmias),
6
acute
elevation of blood glucose level was associated with an increase
in in-hospital stay, and 30-day and long-term mortality rate, and
there is evidence that the risk of mortality is higher in patients
without a history of DM.
7-10
There is a linear relationship between
acute glycaemic levels and outcomes.
2,7
Pathophysiological
mechanisms are uncertain, but acute hyperglycaemia may be an
epiphenomenon of the stress response, or the trigger of complex
underlying mechanisms, leading to severe complications and poor
outcomes.
4,5
In sub-Saharan Africa, data on ACS are scarce,
11,12
particularly on
the prevalence and outcomes of patients with acute hyperglycaemia.
The aim of this study was to assess the prognostic value of
hyperglycaemia at admission in ACS patients in our practice.
Methods
Our study was carried out at the Abidjan Heart Institute (Ivory
Coast). We conducted a cross-sectional, observational study
between 1 January 2002 and 31 December 2017, including patients
aged ≥ 18 years who presented to the intensive care unit (ICU) of
Abidjan Heart Institute for ACS. These patients were divided into
two groups according to their blood glucose level at admission:
admission hyperglycaemia (AH) (blood glucose > 140 mg/dl; 7.8
mmol/l) and absence of admission hyperglycaemia (NAH) (blood
glucose ≤ 140 mg/dl).
4
The blood glucose level considered was the
first venous plasma glucose level obtained at admission or within
the first 24 hours, and before any glucose-lowering therapy was
given during hospitalisation.
The exclusion criteria were: ACS patients with incomplete
medical records or who declined to participate in the study, patients
with suspected ACS in whom the clinical course and explorations
had excluded the diagnosis of ACS, and patients transferred to
another department outside the Abidjan Heart Institute during
their hospitalisation.
Consent was obtained from each patient participating in this
study. Based on our selection criteria, 1 168 patients were included
in our study.
Data were collected using a standardised survey form. The
parameters investigated were: (1) socio-demographic data
(age, gender) as well as clinical data (cardiovascular risk factors
and history, clinical presentation); (2) ECG (diagnosis of ACS)