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العنوان
Impact of Admission Glycated Hemoglobin on Angiographic characteristics and Short Term Clinical Outcomes of Non-diabetic patients with Acute ST Elevation Myocardial Infarction/
المؤلف
Bassily, Rami Adel Youssef.
هيئة الاعداد
باحث / Rami Adel Youssef Bassily
مشرف / Ali Ahmed Ibrahim El Abd
مشرف / Haitham Galal Mohammed
مشرف / Ehab Mohamed El Fekky
تاريخ النشر
2019.
عدد الصفحات
150 p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
أمراض القلب والطب القلب والأوعية الدموية
تاريخ الإجازة
1/1/2019
مكان الإجازة
جامعة عين شمس - كلية الطب - القلب والأوعية الدموية
الفهرس
Only 14 pages are availabe for public view

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from 165

Abstract

Coronary artery disease is the most important cause of death in industrialized countries. The relative incidences of STEMI and NSTEMI are decreasing and increasing, respectively. Probably the most comprehensive European STEMI registry is found in Sweden, where the incidence rate of STEMI was 58 per 100 000 per year in 2015. There is a consistent pattern for STEMI to be relatively more common in younger than in older people, and more common in men than in women.
The categories of patients with STEMI, NSTEMI, or unstable angina are customarily included in the concept of ACS. In addition to these categories, MI may be classified into various types based on pathological, clinical, and prognostic differences, along with different treatment strategies. Despite the fact that the majority of STEMI patients are classified as a type 1 MI (with evidence of a coronary thrombus), some STEMIs fall into other MI types. MI, even presenting as STEMI, also occurs in the absence of obstructive coronary artery disease (CAD) on angiography. This type of MI is termed ‘myocardial infarction with non-obstructive coronary arteries’ (MINOCA).
Diabetes mellitus (DM) is one of the largest global health emergencies of the 21st century. DM is also a major risk factor for cardiovascular disease (CVD), which is the most common cause of death among adults with DM as the burden of cardiovascular disease attributable to diabetes has increased over the past two decades.
“Pre-diabetes” is the term used for individuals whose glucose levels do not meet the criteria for diabetes but are too high to be considered normal. Patients with pre-diabetes are defined by the presence of IFG and/or IGT and/or HbA1C 5.7–6.4% (39–47 mmol/mol). Pre-diabetes is associated with obesity (especially abdominal or visceral obesity), dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension.
HbA1c is now better standardized. There is less biologic variability and pre-analytic instability. HbA1c gives a better measure of overall glycemic exposure and likely risk for long-term complications. There is no need for fasting or timed samples, and HbA1c is less affected by conditions that produce perturbations in glucose levels. Moreover, it is a better guide to clinical management of patients. For these reasons, it is likely that HbA1c will become a standard approach to the diagnosis and clinical management of type 2 diabetes. For the diagnosis of diabetes, the expert committee recommended an HbA1c threshold of 6.5%. The ADA recently proposed a pre-diabetes range of 5.7% to 6.4%.
In this observational study, 100 patients were enrolled after fulfilling the inclusion criteria. At admission, glycated hemoglobin was recorded & accordingly patients were divided in 3 groups: the normal HbA1C group (50 patients), the pre-DM group (36 patients) & the accidentally diagnosed DM (14 patients). SYNTAX score as well as thrombus burden & TIMI flow were obtained from the coronary angiography of each patient & finally echocardiography was done documenting EF (ejection fraction), LV dimensions & development of any mechanical complications such as mitral regurgitation. Patients were followed during their hospital stay for development of any major adverse cardiac events (MACE) & finally for the development of CIN (contrast induced nephropathy).
There were 2 highly statistically significant difference found between the 3 groups regarding:
1. Thrombus burden, where a high percentage from the diabetes group (35.7%, n=5) had a very high grade of thrombus burden while it was 4% in the first group & 5.6% in the pre-diabetes group.
2. MACE, where the highest percentage occurred in the diabetes group 35.7% (n=5).
In our study we found a strong positive correlation between HbA1C & SYNTAX score. The higher HbA1C level on admission, the higher is the SYNTAX score with more complex coronary lesions. Another correlation was noted with the EF, this time it’s an inverse one: the higher HbA1C level on admission the lower was the EF. We also concluded highly significant correlation between HbA1C & both thrombus burden & MACE during hospital stay. With higher level of HbA1C, thrombus burden is high where grade 5 thrombus burden is associated with HbA1C ranging from 5.5 to 11.6 with mean 7.27. For the development of MACE, patients had an HbA1C ranging from 5.6 to 8.8 with mean 6.68.
from this current study we concluded that higher HbA1C level at admission in non-diabetic patients presented by acute STEMI, is associated with more severe CAD by SYNTAX score, MACE & thrombus burden. Introducing measurement of HbA1C in the CCU seems to be a simple method to assess cardiovascular risk in a non-diabetic population with ACS.