Transient hyperglycemia in acute coronary heart disease

Abstract

Objective. To identify the features of transient hyperglycemia in dynamics in acute coronary heart disease in patients without impaired glycemic metabolism.Materials and methods. We performed a retrospective analysis of 178 medical records of inpatients with acute forms of coronary heart disease: transmural myocardial infarction (MI), subendocardial MI, unstable angina - initially urgently hospitalized and further treated in the institution “Gomel Regional Clinical Cardiology Center” in 2021-2022. All the patients were examined and treated in accordance with the clinical protocol for the diagnosis and treatment of diseases of the circulatory system [1]. Venous blood glucose level in dynamics was measured at hospitalization during the first hours of the disease not on an empty stomach and then on an empty stomach on the 1st, 2nd, 3rd, 4th and 5th day; according to EchoCG data on the 1st-3rd day included the ejection fraction (EF) and local contractility index (LCI). The patients were divided into groups depending on the disease, blood glucose level at hospital admission (not requiring pharmacological correction 4.1–10.9 mmol/l, requiring pharmacological correction 11 mmol/l and more [1]) and the presence/absence of a rise in blood glucose levels on the first day of hospitalization (the 1st day of the diseases).Results. Transient hyperglycemia in acute forms of coronary heart disease in patients without impaired glycemic metabolism is most evident with transmural MI, hyperglycemia of more than 11.0 mmol / l occurs in 7% of cases of all transmural MI, of which 28.5% persists on the 1st day, which requires continued pharmacological correction. Relative normalization of glucose at initial glucose values up to 11 mmol/l occurs on the 2nd day, with a tendency in transmural myocardial infarction and glucose levels over 11 mmol/l - on the 3rd day, of MI and an episode of glucose level rise in dynamics — on the 4th day of MI. Transient hyperglycemia with subendocardial MI and unstable angina is not characterized by an increase in glucose more than 11.0 mmol/l, with relative normalization on the 2nd day, while higher glucose levels are observed at admission compared to those with unstable angina.Conclusion. Transient hyperglycemia over 11 mmol/l in transmural MI in patients without glycemic metabolism disorders in 28.5% of cases remains on the 1st day of MI, which requires continued medication correction of hyperglycemia. Subendocardial MI and unstable angina are not characterized by the occurrence of transient hyperglycemia, requiring pharmacological correction, with relative normalization of the index by 2nd day.