Abstract
Background: Dysglycemia is a major and increasingly prevalent cardiometabolic risk factor worldwide, but often is undiagnosed even among high-risk patients with cardiovascular disease. New risk reduction strategies for DM are available, but little is known about their uptake in low middle-income countries. Methods: We conducted a prospective NORIN STEMI registry-based study of patients presenting with STEMI to 2 government-funded tertiary care medical centers in New Delhi, India from January to November 2019. Hemoglobin A1c was collected as a part of the study protocol, irrespective of baseline glycemic status. Prediabetes and DM were defined as screening HbA1c 5.7-6.4% and ≥6.5%, respectively. Results: Among 3,635 patients with STEMI (median age 55[45-62] with 33% ≤50 years, 16% women, 54% BMI≥30kg/m 2 ), 855 (24%) reported a prior history of DM. Among patients with known DM, median HbA1c (available in n=826) was 7.4% (6.4-8.2%). At presentation, 1 patient (0.1%) and 21 patients (2%) were treated with an SGLT2i and GLP-1RA, respectively. Among patients without known DM, median HbA1c (available in n=2,668) was 5.5% (5.1%-5.9%) with 737 (28%) newly identified to have prediabetes and 339 (13%) to have DM. Compared with patients with euglycemia (42%), patients with known or newly detected prediabetes (49%) and DM (49%) experienced higher rates of post-MI LV dysfunction EF≤40% (P<0.0001). In-hospital mortality (4.3%, 5.6%, 8.8%) and 30-day mortality (6.6%, 8.1%, 11.7%) were similarly higher among patients with dysglycemia (P<0.0001 for both). Conclusion: Among patients presenting with STEMI in North India, protocolized HbA1c screening doubled the proportion of patients with known dysglycemia. These patients faced higher rates of LV dysfunction and mortality out to 30 days. Treatment with SGLT2i or GLP-1RA was infrequent.
Published Version
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