Clinical Evaluation Of Glycometabolic Disturbance In Patients With Acute Coronary Syndrome

In recent years, many large scale clinical studies have proved that the incidence of glycometabolic disturbance in patients with coronary heart di- sease increased significantly. And oral glucose tolerance test (OGTT) con- firmed that the postprandial glucose abnormalities were more often obser- ved than fasting glucose abnormalities. Prospective studies from abroad sh- owed that the role of diabetes mellitus (DM) as a risk factor for coronary heart disease started from pre-diabetes stage, earlier than the presence of c- linical DM, and might from, or even earlier than the impaired glucose tole- rance (IGT) stage. Therefore, the correlationship between acute coronary syndrome (ACS) and glycometabolic disturbance has significant clinical importance. This study aims to investigate the prevalence of glycometabolic disturbance in patients with ACS, and to assess the consistency between the OGTT results collected in 48 hours and 1 week after the clinical event in patients with ACS, and the correlations between glycometabolic disturban- ce, glycated hemoglobin A-l-C (HbA1c) and cardiac function in patients wi- th ACS. It may provid a new strategy of secondary prevention for patients with coronary heart disease by early discover and interfere with glycometa- bolic disturbances.Objective: To investigate the prevalence of glycometabolic disturban- ce in patients with ACS, and to assess the consistency between the OGTT results collected in 48 hours and 1 week after the clinical event in patients with ACS, and the correlations between glycometabolic disturbance, HbA1c and cardiac function in patients with ACS.Methods: Ninety four patients with ACS but without previous DM, who were admitted to CCU from January 2008 to February 2009, were included. According to the definition of ACS, 94 patients were divided into three groups: unstable angina, non-ST-segment elevation myocardial infarction, ST-segment elevation myocardial infartion. Blood glucose level were tested in admission, simplified OGTT tests were conducted within 48 hours and 1 week after the coronary artery event, HbA1c was tested within 48 hours af- ter the clinical event. The blood glucose levels were compared among the three groups.Results: According to the OGTT results collected in 48 hours, glyco- metabolic disturbance was seen in 72/94 patients (76.5%), the prevalences of newly diagnosed DM and impaired glucose regulation(IGR) were 28.7% (27 patients) and 47.8% (45 patients) respectively. According to the OGTT results collected 1 week after the clinical event, glycometabolic disturbance was seen in 66/94 patients (70.2%), the prevalences of newly diagnosed DM and IGR were 24.5% (23 patients) and 45.7% (43 patients) respectively. Compared with that collected in 48 hours, patients with glycometabolic dis- turbance were reduced by 6.3% (6 patients), including newly diagnosed DM in 4 patients (4.2%) and IGR in 2 patients (2.1%). The overall change of glycometabolic disturbance within one week was not statistically signifi- cant (P>0.05), indicated that the glycometabolic status had improved only in a few patients within one week. Significant correlations between glyco- metabolic disturbance, HbA1c and left heart systolic, diastolic function in patients with ACS were observed (P<0.05).Conclusion: Newly diagnosed DM and IGR was common in patients with ACS and without previous DM history. The OGTT results collected in 48 hours were consistent with that collected 1 week after the clinical event in patients with ACS. With the aggravation of infarct extent and the expan- sion of infarct area, stress may also involved in the formation of glycometa- bolic disturbance.The glycometabolic disturbance, HbA1c level showed sig- nificant correlations with left heart systolic and diastolic function in patien- ts with ACS.