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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
44
VOLUME 17 NUMBER 2 • NOVEMBER 2020
Table 1.
Patient characteristics according to glycaemia status at
admission
AH
NAH
Characteristics
n
= 474
n
= 694
p
-value
Age (years), m ± SD
57.9 ± 11.0
54.7 ± 11.8 < 0.001
Age > 60 years
193 (40.7)
220 (31.7)
0.001
Female gender
42 (19.8)
94 (15.1)
0.10
Hypertension
312 (65.8)
377 (54.3)
< 0.001
Diabete mellitus
262 (55.3)
70 (10.1)
< 0.001
Active smoking
113 (23.8)
222 (32.0)
0.002
Dyslipidaemia
149 (31.4)
216 (31.1)
0.91
Familial history of CAD
27 (5.7)
44 (6.3)
0.65
History of MI
42 (8.9)
58 (8.4)
0.76
History of stroke
24 (5.1)
23 (3.3)
0.13
Admission delay (hours),
m (IQR)
15 (5–52)
20 (5–48)
0.37
Systolic BP (mmHg),
m ± SD
148.8 ± 34.3
143.5 ± 29.1
0.01
Diastolic BP (mmHg),
m ± SD
92.1 ± 21.2
88.1 ± 19.0 < 0.001
Heart rate (bpm),
m ± SD
89.4 ± 20.9
81.8 ± 18.8 < 0.001
Congestive heart failure
168 (35.4)
144 (20.7)
< 0.001
LVEF < 40%
210 (44.3)
198 (28.5)
< 0.001
ECG findings 0.005
Anterior ACS
274 (57.8)
321 (63.6)
Inferior ACS
169 (35.7)
315 (45.4)
Lateral ACS
31 (6.5)
58 (8.4)
Troponine Ic peak (μg/l),
m (IQR)
13.1 (5.2–30.0) 4.9 (1.4–15.0)
0.004
CPK peak (UI/l), m (IQR)
1083 (436–2680) 714 (245–1900) < 0.001
CKMB peak (UI/l), m (IQR)
91 (40–242)
65 (26–171) < 0.001
STEMI
369 (77.8)
431 (62.1)
< 0.001
Atrial fibrillation
16 (3.4)
22 (3.2)
0.84
SVT/VF
18 (3.8)
25 (3.6)
0.86
Cardiogenic shock
31 (6.5)
20 (2.9)
0.002
PCI
81 (17.1)
139 (20.1)
0.21
DAPT
455 (65.6)
327 (69.0)
0.22
Death
72 (15.2)
34 (4.9)
< 0.001
Length of stay (days),
m ± SD
9.0 ± 5.9
8.4 ± 5.3
0.03
Severity of CAD
n
= 144
n
= 420
0.51
Non significant CAD
23 (16.0)
59 (14.0)
1-vessel CAD
48 (34.0)
162 (38.6)
2-vessel CAD
44 (30.6)
135 (32.1)
3-vessel CAD
28 (19.4)
64 (15.2)
Data are in
n
(%), means ± standard deviation or median (interquartile range).
AH: admission hyperglycaemia. NAH: absence of admission hyperglycaemia.
CAD: coronary artery disease. BP: blood pressure. MI: myocardial infarction.
LVEF: left ventricular ejection fraction. STEMI: ST-segment elevation myocardial
infarction. SVT/VF: sustained ventricular tachycardia/ventricular fibrillation.
DAPT: dual antiplatelet therapy. PCI: percutaneous coronary intervention.
curve = 0.636; sensitivity 61%, specificity 67%;
p
< 0.001) (Fig. 1).
Considering the value of 140 mg/dl (7.8 mmol/l), we found similar
sensitivity and specificity (sensitivity 62%, specificity 60%).
Discussion
Whereas estimation of the prevalence of DM in ACS patients is
known in sub-Saharan Africa, ranging from 25 to 41%,
11,16
to
our knowledge this is the first study reporting the prevalence of
blood glucose levels at admission and their prognostic value on
in-hospital mortality in our practice. The prevalence of admission
hyperglycaemia (40.6%) was higher than the prevalence of DM
(28.4%). This high rate of acute hyperglycaemia is consistent
with available data in the literature in wealthy countries, where
the prevalence of hyperglycaemia > 140 mg/dl (7.8 mmol/l) ranges
from 39 to 58%.
1,2,5
However, the blood glucose cut-off point
differs across studies, and it has been reported that up to 71% of
ACS patients had acute hyperglycaemia.
3
The prognostic impact of hyperglycaemia on admission in
patients hospitalised for ACS has been established in numerous
studies.
7-10
The Cooperative Cardiovascular Project
7
is the most
important registry (
n
= 141 680) that evaluated the relationship
between mortality rate and admission blood glucose after ACS.
Mortality at 30 days and one year evolved linearly with blood
glucose levels at admission (≤ 110, 110–140, 140–170, 170–240
and ≥ 240 mg/dl) (6.11, 6.11–7.8, 7.8–9.44, 9.44–13.32 and ≥
13.32 mmol/l). As in our study, the risk of mortality was higher in
patients without a history of DM.
7
In a recent meta-analysis including 214 219 patients, admission
hyperglycaemia significantly increased hospital mortality rate (HR
= 3.62;
p
< 0.0001), and this impact persisted at 30 days (HR =
4.81,
p
< 0.0001) and long term up to 108 months (HR = 2.02,
p
< 0.0001).
3
In STEMI patients who underwent primary PCI,
hyperglycaemia was associated with a higher rate of complications
and mortality, including the risk of recurrence of myocardial
infarction and heart failure.
17
Table 2.
Predictors of in-hospital death. Univariate analysis
Death during
Alive at
hospita-
discharge
lization
Predictors
(
n
= 1062) (
n
= 106)
HR
95% CI
p
-value
Age > 60 years 361 (34.0)
52 (49.1)
1.87 1.25–2.79 0.002
Female gender
195 (18.4)
30 (28.3)
1.75 1.12–2.75 0.01
Hypertension
619 (58.3)
70 (66.0)
1.39 0.91–2.12 0.12
Diabete mellitus 288 (27.1)
44 (41.5)
1.91 1.27–2.87 0.002
Active smoking 313 (29.5)
22 (20.8)
0.63 0.38–1.02 0.06
Dyslipidaemia
342 (32.2)
23 (21.7)
0.58 0.36–0.94 0.03
History of MI
92 (8.7)
8 (7.5)
0.86 0.40–1.82 0.69
Admission delay
(hours), m (IQR) 18 (5–48)
25 (6–72)
–
–
0.02
Congestive heart
failure
249 (23.4)
63 (59.4)
4.78 3.17–7.23 < 0.001
LVEF < 40%
322 (30.3)
86 (81.1)
9.88 5.97–16.36 < 0.001
Anterior ACS
527 (49.6)
68 (64.2)
1.82 1.20–2.75 0.004
Admission
hyperglycaemia 402 (37.9)
72 (67.9)
3.48 2.27–5.32 < 0.001
STEMI
707 (66.6)
93 (87.7)
3.59 1.98–6.51 0.01
Atrial fibrillation
35 (3.3)
3 (2.8)
0.85 0.26–2.83 0.54
SVT/VF
33 (3.1)
10 (9.4)
3.24 1.55–6.79 < 0.001
Cardiogenic
shock
23 (2.2)
28 (26.4) 16.22 8.92–29.48 < 0.001
DAPT
716 (67.4)
66 (62.3)
0.80 0.53–1.21 0.28
PCI
212 (20.0)
8 (7.5)
0.32 0.16–0.68 0.002
Data are in
n
(%) or median (interquartile range). HR: hazard ratio. 95%
CI: 95% confidence interval. MI: myocardial infarction. LVEF: left ventricular
ejection fraction. ACS: acute coronary syndrome. STEMI: ST-segment
elevation myocardial infarction. SVT/VF: sustained ventricular tachycardia/
ventricular fibrillation.
DAPT: dual antiplatelet therapy. PCI: percutaneous coronary intervention