Short-term and long-term adverse cardiovascular events across the glycaemic spectrum in patients with acute coronary syndrome: the Gulf Registry of Acute Coronary Events-2.

ABSTRACT

BACKGROUND: Limited data exist on the prognostic impacts of diabetes mellitus (DM) and new-onset hyperglycaemia (NOH) on cardiovascular outcomes in Middle Eastern patients with acute coronary syndrome (ACS). Here, we explored this relationship in a large contemporary Middle Eastern ACS registry the second Gulf Registry of Acute Coronary Events (Gulf RACE-2). PATIENTS AND METHODS: Our analysis included 6362 consecutive ACS patients enrolled from October 2008 to June 2009, with or without a known DM diagnosis, and with an available fasting blood sugar measurement from the index hospitalization. Baseline demographics, risk factors for atherosclerosis, medical history, investigations and therapies were registered. Adverse hospital outcomes, as well as short-term and long-term mortalities were compared. Comparisons for categorical data were performed using χ or Fisher's exact tests, whereas analysis of variance or the Kruskal-Wallis test was used for continuous variables. Multiple logistic regression models were used to estimate the odds ratio. RESULTS: Almost half of the ACS cohort had been diagnosed previously with DM, and 8.8% had NOH. DM patients were more frequently older, female and Arab Gulf nationals. Compared with nondiabetic patients, DM patients had higher rates of adverse in-hospital clinical events, and 30-day and 1-year mortality. NOH was an independent predictor of in-hospital mortality, major bleeding and cardiogenic shock. Patients with NOH had higher in-hospital mortality (8.29 vs. 5.37%, P=0.035), ventricular arrhythmia (4.97 vs. 1.91%, P<0.001) and cardiogenic shock rates (6.45 vs. 4.12%, P=0.019) compared with DM patients not requiring insulin. CONCLUSION: DM was very common among ACS patients in the Arab Gulf area, and ACS patients with NOH were at a higher risk compared with euglycaemic patients and diabetic patients not requiring insulin. Further studies are needed to examine the clinical impact of in-hospital intensive glycaemic control in these patients and to explore the long-term glycaemic status of ACS patients with NOH.