Prevalence of prediabetes in patients with acute coronary syndrome: impact on in‐hospital outcomes

Abushady, Manal; Mohamady, Y.; Enany, Basem; Nammas, Wail

doi:10.1111/imj.12651

Cited by 8 publications

(7 citation statements)

References 20 publications

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“…Interestingly, only 7% of diabetes were detected by all three methods of FPG, 2hPG, and HbA 1c . In patients with ACS, previous studies investigating the prevalence of undiagnosed Type 2 diabetes using OGTT during admission (or following discharge) have found higher absolute proportions compared to our study (20–30%) [5, 17, 18]. The higher percentage of diagnosis is likely due to the OGTT having previously shown to have higher a sensitivity for detecting Type 2 diabetes than HbA 1c in patients with ACS [19, 20].…”

Section: Discussioncontrasting

confidence: 73%

HbA1c screening for new onset diabetes following acute coronary syndrome: is it a worthwhile test in clinical practice?

Lugg

May²,

Tuffley³

et al. 2017

J Diabetes Metab Disord

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BackgroundDiabetes and pre-diabetes are prevalent in acute coronary syndrome (ACS) and relate to adverse outcomes. This study used HbA1c to screen for degrees of glucose intolerance amongst patients without known diabetes presenting with ACS.MethodsOver a 1-year period (June 2014–2015) consecutive patients admitted to a single centre cardiology unit with an initial diagnosis of ACS without prior diabetes diagnosis were electronically referred to our diabetes team. Patients were screened for the presence of diabetes by use of an initial HbA1c blood test on day 2 or 3 post admission. If abnormal (≥42 mmol/mol; ≥6.0%), patients were invited for a repeat HbA1c at 2 weeks, and if an intermediate result (42–47 mmol/mol; 6.0–6.4%), for an oral glucose tolerance test (OGTT) at 3 months. Patients were diagnosed with Type 2 diabetes if the repeat HbA1c result was high (≥48 mmol/mol; ≥6.5%) or the OGTT at 3 months confirmed the diagnosis. Other data collected included baseline demographics, risk factors and any history of cardiovascular disease. All patients with ACS were stratified according to the diagnosis and subsequent management.ResultsWe screened 399 patients in total. The mean age was 65 ± 14 years, 268 (67%) were men, 290 (73%) were Caucasian, 95 (24%) were South Asian and 14 (4%) were Afro-Caribbean ethnicity. Of all patients, 57 (14.3%) were diagnosed as pre-diabetes and 43 (10.8%) newly diagnosed diabetes. During the study 28 (7%) patients could not be classified; 6 (1.5%) patients died during the study and 22 (5.5%) patients were missing either initial or repeat HbA1c and were subsequently lost to follow up. Of the baseline variables assessed, there were significantly more patients of South Asian ethnicity in the diabetes group compared to the normal group (42 vs 20%; p = 0.003). There was no difference in detection rates in patients with more severe ACS requiring percutaneous or cardiac surgical intervention.ConclusionsThe use of a simple HbA1c screening method in clinical practice can detect new onset diabetes in approximately 1 in 10 high-risk post ACS patients.

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Section: Discussioncontrasting

confidence: 73%

HbA1c screening for new onset diabetes following acute coronary syndrome: is it a worthwhile test in clinical practice?

Lugg

May²,

Tuffley³

et al. 2017

J Diabetes Metab Disord

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show abstract

“…Last but not least, recent experiment found that baseline plasma fibrinogen is associated HbA1c levels in ACS patients [56]. Fibrinogen is an important part of coronary thrombosis, which is consistent with that higher HbA1c levels were significantly related to increased refraction in ACS patients [25, 27, 41].…”

Section: Discussionsupporting

confidence: 60%

Prognostic value of HbA1c for in-hospital and short-term mortality in patients with acute coronary syndrome: a systematic review and meta-analysis

Pan

Lü

Lian

et al. 2019

Cardiovasc Diabetol

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BackgroundHbA1c, the most commonly used indicator of chronic glucose metabolism, is closely associated with cardiovascular disease. However, the relationship between HbA1c and the mortality of acute coronary syndrome (ACS) patients has not been elucidated yet. Here, we aim to conduct a systematic review assessing the effect of HbA1c on in-hospital and short-term mortality in ACS patients.MethodsRelevant studies reported before July 2019 were retrieved from databases including PubMed, Embase, and Central. Pooled relative risks (RRs) and the corresponding 95% confidence interval (CI) were calculated to evaluate the predictive value of HbA1c for the in-hospital mortality and short-term mortality.ResultsData from 25 studies involving 304,253 ACS patients was included in systematic review. The pooled RR of in-hospital mortality was 1.246 (95% CI 1.113–1.396, p: 0.000, I2 = 48.6%, n = 14) after sensitivity analysis in studies reporting HbA1c as categorial valuable. The pooled RR was 1.042 (95% CI 0.904–1.202, p: 0.57, I2 = 82.7%, n = 4) in random-effects model for studies reporting it as continuous valuable. Subgroup analysis by diabetic status showed that elevated HbA1c is associated increased short-term mortality in ACS patients without diabetes mellitus (DM) history and without DM (RR: 2.31, 95% CI (1.81–2.94), p = 0.000, I2 = 0.0%, n = 5; RR: 2.56, 95% CI 1.38–4.74, p = 0.003, I2 = 0.0%, n = 2, respectively), which was not the case for patients with DM and patients from studies incorporating DM and non-DM individuals (RR: 1.16, 95% CI 0.79–1.69, p = 0.451, I2 = 31.9%, n = 3; RR: 1.10, 95% CI 0.51–2.38), p = 0.809, I2 = 47.4%, n = 4, respectively).ConclusionsHigher HbA1c is a potential indicator for in-hospital death in ACS patients as well as a predictor for short-term mortality in ACS patients without known DM and without DM.

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“…Our ULTRAMAN registry showed a better success rate and similar low complications for ACS (175 patients) compared to the CAMEL study (laser technical success: 92.5% vs. 89%; PCI success: 94.5% vs. 93%; death: 1.7% vs. 4%; perforation: 1.1% vs. 0.6%; major dissection: 1.1% vs. 5%; and slow flow/no-reflow: 6.9% vs. 3%, respectively), perhaps due to technical advances over the past decade. In addition, the rate of MACCE at 1 month after ACS in the ULTRAMAN registry was 2.4%, which was more favorable as compared to the value of the previous reports using conventional methods (5-10%) [15,16]. Shishikura et al compared the effects of ELCA and manual aspiration for ACS [17].…”

Section: Elca For Acsmentioning

confidence: 90%

Indications and outcomes of excimer laser coronary atherectomy: Efficacy and safety for thrombotic lesions—The ULTRAMAN registry

Nishino

Mori

Takiuchi

et al. 2017

Journal of Cardiology

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Prevalence of prediabetes in patients with acute coronary syndrome: impact on in‐hospital outcomes

Abstract: Prediabetes is common in patients presenting with ACS who are not previously known to have diabetes. Prediabetic patients had worse in-hospital clinical outcomes compared with patients without diabetes.

Cited by 8 publications

References 20 publications

HbA1c screening for new onset diabetes following acute coronary syndrome: is it a worthwhile test in clinical practice?

HbA1c screening for new onset diabetes following acute coronary syndrome: is it a worthwhile test in clinical practice?

Prognostic value of HbA1c for in-hospital and short-term mortality in patients with acute coronary syndrome: a systematic review and meta-analysis

Indications and outcomes of excimer laser coronary atherectomy: Efficacy and safety for thrombotic lesions—The ULTRAMAN registry

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