Prognostic Implication of Stress Induced Hyperglycemia in Non Diabetic Patients with Acute Coronary Syndrome

Abstract

BACKGROUND Hyperglycemia is a common finding during the admission of non-diabetic patients with acute coronary syndrome. It is very essential to differentiate this stress hyperglycemia from the hyperglycemia in latent diabetics whose diabetes may have been unmasked by the stress of acute coronary syndrome (ACS). We conducted this study to evaluate stress hyperglycemia in non-diabetic patients with ACS. METHODS We conducted this cross sectional study in the Department of Medicine, KIMS Hospital, Karad, over a period of one year. Non-diabetic patients with HbA1c < 6.5 admitted in our hospital with ACS were included in the study. We included a total of 100 patients in our study, their detailed history, clinical examination and lab evaluation was done. We divided the patients into two groups, Group A were normoglycaemic patients and Group B were acute phase hyperglycemic patients with blood sugars more than 160. Correlation between the blood sugar levels and outcome of the patients was done. RESULTS Mean age was 65.23 ± 21.05 years. No significant difference in risk factor distribution in the two groups was seen. (p > 0.05) We had 47 cases of unstable angina (UA – 47%) followed by 43 cases of STEMI (43 %) and 10 cases of NSTEMI (10 %). We observed a significant difference in the presence of complications in the two groups (p<0.001), Group B patients with hyperglycemia had more complications. Significant difference was seen between the presence of heart failure, arrhythmias and shock in the two groups, with group B having more incidences of these (p<0.05). Significant difference in the outcome of the two groups was seen (p = 0.012). We observed that out of 38 patients in Group B with hyperglycemia, there were 8 deaths (21.05%) as compared to 3 deaths (4.84%) in Group A patients. CONCLUSIONS We observed that the high prevalence (38%) of stress in non-diabetic ACS patients is responsible for significantly more complications, more chances of heart failure, arrhythmia, shock and more deaths. KEY WORDS Acute Coronary Syndrome, Stress Hyperglycemia, Non-Diabetic Patients, Outcome