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Acute to chronic glycemic ratio clinical value in acute coronary syndrome
Session:
Painel 6 - Doença Coronária 10
Speaker:
Fernando Gonçalves
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Fernando Fonseca Gonçalves; José P. Guimarães; Sara Borges; José J. Monteiro; Pedro S. Mateus; Ilidio Moreira; On behalf of the investigators of the Portuguese Registry of Acute Coronary Syndromes
Abstract
<p><u>Introduction:</u> Stress hyperglycemia (SH) is a prognostic marker in acute coronary syndrome (ACS). This study aimed to evaluate the clinical and prognostic value of the acute to chronic glycemic ratio (ACR) in ACS and compare it with SH.</p> <p><u>Methods:</u> This was a retrospective study of patients hospitalized for ACS periodically included in a national multicenter registry between October 2010 and January 2019. The "acute" glucose (Gl) value was assessed at admission and chronic blood glucose was calculated by the formula 28,7×HbA1c-46,7. SH was defined as admission Gl ≥180mg/dL. The endpoints evaluated consisted of in-hospital death/stroke/myocardial infarction (MACE) and mortality.</p> <p><u>Results:</u> Of a total of 5501 patients, 33,7% were in the ACR lower tertile (<0,96), 33,4% in the intermediate tertile (0,96-1,22) and 32,9% in the upper tertile (≥1,23). The upper tertile had more female patients, older patients and, therefore, less smokers and more hypertensive and diabetic patients. These patients had more multivessel coronary disease (53,5% <em>vs</em> 51,2% <em>vs</em> 58,3%, <em>p</em><0,001) and were less likely to have angioplasty performed (69,2% <em>vs</em> 71,6% <em>vs</em> 65,7%, <em>p</em><0,001). Left ventricular systolic function was also worse in the upper tertile (54±12% <em>vs</em> 53±12% <em>vs</em> 50±13%, <em>p</em><0,001).</p> <p>The presence of SH also distributed patients similarly, with one exception. Despite the higher presence of multivessel disease with SH (50,7% <em>vs</em> 63,9%, <em>p</em><0,001), there were no significant differences in angioplasty (69,5% <em>vs</em> 67,1%, <em>p</em>=0,083).</p> <p>During hospitalization, the higher the ACR, the higher the number of MACE (11,8% <em>vs</em> 15,8% <em>vs</em> 29%, <em>p</em><0,001) and mortality (1% <em>vs</em> 1,6% <em>vs</em> 4,5%, <em>p</em><0,001). SH was also associated with more adverse events (15,2% <em>vs</em> 28,2%, <em>p</em><0,001 and 1,7% <em>vs</em> 4,2%, <em>p</em><0,001, for both endpoints respectively).</p> <p>Overall, ROC curve analysis did not show superiority of ACR over SH for MACE (AUC 0,64 <em>vs</em> 0,63, <em>p</em>=0,087). However, the ACR was better than SH for in-hospital death (AUC 0,70 <em>vs</em> 0,66, <em>p</em>=0,010). In diabetic patients ACR was better than SH for MACE (AUC 0,63 <em>vs</em> 0,60, <em>p</em>=0,005), but not for death (AUC 0,68 <em>vs</em> 0,66, <em>p</em>=0,294). In non-diabetic patients there were no differences for either MACE (AUC 0,64 <em>vs</em> 0,64, <em>p</em>=0,668) nor for death (AUC 0,70 <em>vs</em> 0,70, <em>p</em>=0,573).</p> <p><u>Conclusions</u>: The ACR was able to identify patients with more severe coronary events. Moreover, it was a significant predictor of adverse events and, in some situations, it was a better prognostic indicator than SH.</p>
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