IMPACT OF ACUTE / CHRONIC GLYCEMIC RATIO ON IN-HOSPITAL MAJOR ADVERSE CARDIOVASCULAR OUTCOMES IN PATIENT WITH ACUTE CORONARY SYNDROMES AND DIABETES MELLITUS

Abstract

Background : Hyperglicemia is common and known as a determinant of adverse outcomes in Acute Coronary Syndrome (ACS), but acute fluctuation of blood glucose rather than chronic and stable hyperglicemia produces more oxidative stress. Therefore, combined acute and chronic blood glucose will reveal true acute glycemic rise. Particularly in patients with diabetes, in whom elevated blood glucose do not necessarily indicate the occurrence of acute hyperglicemia.

Methods : Data were collected from 126 consecutive patients with ACS and diabetes in Cardiac Centre Haji Adam Malik General Hospital Medan. We measured acute/chronic glycemic ratio by comparing blood glucose at admission and chronic estimation ([28.7 x HbA1c] – 46.7). Then we observed in hospital Major Adverse Cardiovascular Outcomes (MACEs) which consist of cardiovascular mortality, acute heart failure, malignant arrhythmia and cardiogenic shock. Statistical analysis was performed using mean difference, logistic regression, and receiver operating curve (ROC).

Results : Among 126 patients, MACEs were observed in 61 (48.4%) patients with the most common MACE was acute heart failure (25.2%). Bivariate analysis showed a significant relationship between the acute/chronic glycemic ratio and in hospital MACEs (p < 0.001). Acute/chronic glycemic ratio had AUC value 88.8%. The optimal cut-off value was 1.05 (sensitivity 83.6% ; specificity 75.4%). In multivariate logistic regression analysis, the acute/chronic glycemic ratio was the strongest predictor with an OR value of 15.781 (95% CI 6.15- 40.46; p value <0.001).

Conclusions : Acute/chronic glycemic ratio can predict in-hospital MACE in ACS and DM patients with the cut-off value obtained was 1.05.