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07. Syncope and Bradycardia
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Prevalence and predictors of glucose metabolism disorders after Acute Coronary Syndrome
Session:
Painel 12 - Prevenção / Reabilitação Cardíaca3
Speaker:
Geraldo Faia Carvalho Dias
Congress:
CPC 2020
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.7 Diabetes and the Heart
Session Type:
Posters
FP Number:
---
Authors:
Geraldo Dias; Bebiana Faria; Sílvia Sanz; Sílvia Ribeiro; Pedro von Hafe; Ana Filipa Cardoso; Tamara Pereira; Anabela Azevedo; Filipa Almeida; António Lourenço
Abstract
<p>Introduction: Coronary heart disease is a major determinant of long-term prognosis in patients with diabetes <em>mellitus </em>(DM) and the presence of DM increases mortality risk from cardiovascular disease 2-4 fold. It is therefore important to identify patients with glucose metabolism disorders (GMD), since early life-style modifications and pharmacological therapy allow adequate metabolic control and prevent cardiovascular events.</p> <p>Objectives: The objective of this study was to ascertain the prevalence of GMD during and after hospitalization for acute coronary syndrome (ACS).</p> <p>Methods: A <em>Cohort </em>study was performed comprising patients admitted in the cardiac intensive care unit between october 2017 and september 2018 with a final diagnosis of ACS. Patients were excluded from this study if they had a previous or an at admission diagnosis of DM. The values of HbA1c at admission and fasting plasma glucose at the day of discharge were obtained, and an oral glucose tolerance test (OGTT) was performed, at least, 1 month after discharge.</p> <p>Results: A total of 74 patients were included, having a mean age of 61 years, of which 85% were of the male gender. 46% of the patients had dyslipidemia, 43% had arterial hypertension, 21% were obese, and 18% had an history of coronary artery disease. Regarding the admission diagnosis, 35% of the patients were admitted for acute myocardial infarction (AMI) with ST segment elevation, 46% for non-ST segment elevation AMI and 19% for unstable angina. The mean value of HbA1c at admission was 5.8 ± 0.4% and 59.5% of the patients presented with pre-diabetes criteria (HbA1c: 5.7-6.4%). The mean fasting plasma glucose at the time of discharge was 95 ± 14mg/dL. After OGTT, 48.6% of the patients had GMD, where 9.5% of the patients fulfilled DM diagnostic criteria and 39.1% pre-diabetes criteria. Of these patients, only 17.6% had normal HbA1c at admission (HbA1c <5.7%). Higher values of HbA1c at admission (p <0.001) and fasting plasma glucose at discharge (p =0.003) were significantly associated with the presence of GMD (diabetes or pre-diabetes) after OGTT; however, only the value of HbA1c was revealed to be an independent predictor (p= 0.008, OR: 14). A value of HbA1c≥6% at admission was significantly associated with the presence of DM diagnostic criteria in the OGTT (p = 0.041).</p> <p>Conclusion: There was a high prevalence of pre-diabetes (59.5%) at the time of discharge in patients admitted for ACS. The OGTT, after acute phase, identified 48.6% patients with GMD, of whom, 9.5% met DM criteria. The value of HbA1c at admission was an independent predictor of GMD in OGTT and an HbA1c≥6% was significantly associated with the presence of DM criteria.</p>
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