Prevalence of Preexisting Dysglycaemia among Inpatients with Acute Coronary Syndrome and Associations with Outcomes

Abstract

Objective: We aimed to determine the prevalence of preexisting dysglycaemia in inpatients admitted with acute coronary syndrome (ACS), their characteristics and, association with acute and 12-month clinical outcomes. Research Design and Methods: In this prospective observational cohort study, admission HbA1c testing was undertaken on consecutive inpatients aged ≥54 years admitted with ACS. Patients were categorised into those with diabetes (prior diagnosis or HbA1c ≥ 6.5%, ≥48mmol/mol), prediabetes (HbA1c 5.7-6.4%, 39-46mmol/mol) and no diabetes (HbA1c <5.6%, <38mmol/mol). Results: Between July 2013 and July 2015, 847 consecutive inpatients aged ≥54 years were admitted with ACS. 313 (37%) inpatients had diabetes, 312(37%) had prediabetes and 222(25%) had no diabetes. After adjusting for age, sex, smoking status and previous myocardial infarction, diabetes, as opposed to no diabetes, was associated with higher odds of Acute Pulmonary Oedema (APO) (OR 2.60, P<0.01), longer length of stay (LOS) (IRR 1.18, P=0.02) and, higher odds of 12-month ACS recurrence (OR 1.86, P<0.05). Prediabetes was not a statistically significant marker of adverse clinical outcomes. However, analysed as a continuous variable, every 1% (11 mmol/mol) increase in HbA1c was associated with increased odds of APO (OR 1.28, P=0.002) and, longer LOS (IRR 1.05, P=0.03). Conclusions: In our study, three-quarters of all inpatients aged ≥54 years admitted with ACS had preexisting dysglycaemia. Inpatients with diabetes had increased odds of APO, longer LOS and higher 12-month ACS recurrence. Higher HbA1c, was associated with increased odds of APO and longer LOS. Randomised studies with cardioprotective anti-hyperglycaemic agents are necessary in determining if improving dysglycaemia in ACS patients improves clinical outcomes. Disclosure D. Mahendran: None. G. Hamilton: None. J. Weiss: None. J. Lew: None. K. Khoo: None. E.I. Ekinci: None.