Impact of Diabetic Status on the Hyperglycaemia Induced Adverse Risk of Short Term Outcomes in Hospitalized Patients with Acute Coronary Syndromes in the Middle East: Findings from the Gulf Registry of Acute Coronary Events (Gulf RACE)

Background While glucose levels on admission are clearly a much stronger predictor of short term adverse outcomes than diabetes status, there is a paucity of data on how diabetes impacts on the hyperglycaemia induced increased risk

Methods 2786 patients admitted to hospital with acute coronary syndrome (ACS) and diabetic level hyperglycaemia (random > 11.1 or fasting > 7 mmol/L) were identified from a Gulf registry of ACS. We divided the cohort into two groups: Those who were previously known to have diabetes mellitus were identified as known diabetes group and those without previous diabetes. We used logistic regression models to assess the effect of glycaemic status on hospital mortality and other patient outcomes including heart failure, stroke, recurrent ischemia, cardiogenic shock, major bleeding and ventilation.

Results About two-thirds of the hyperglycaemics on admission had previously diagnosed diabetes. After adjusting for age, in-hospital mortality was significantly higher in the non-diabetic group (OR: 2.36; 95% CI 1.54 – 3.61) compared to the diabetic group, As for the other outcomes, known diabetes patients had significantly lower incidence of heart failure, cardiogenic shock and ventilation compared to non-diabetic patients.

Conclusion The effects of hyperglycaemia are mitigated by the presence of the chronic diabetic state and thus hyperglycaemia has a worse effect in those not known to have chronic diabetes. These findings are important and call for further investigation.