Acutehyperglycemia on admission is considered to be an independent prognosticator ofboth in-hospital and long-term outcomes regardless of diabetic status inpatients with the acute coronary syndrome (ACS). The objective of this studywas to analyse the incidence of acute hyperglycemia and its impact on the subsequentadverse in-hospital outcome, irrespective of diabetic status, in patients with STE-ACSundergoing primary PCI. 

A total of 4470 patients were enrolled in thestudy, presenting with STE-ACS, and undergoing primary PCI at a tertiary carecardiac centre. Patients were categorised according to their random plasmaglucose levels, at the time of presentation to ER, with RBS > 200mg/dl takenas acute hyperglycemia. All patients were observed during their hospital stayand post-procedure complications and outcomes were recorded. Clinical profilesand outcomes were compared between the two groups. Multivariable logisticregression analysis was performed to determine the predictive value of acutehyperglycemia for the prediction of in-hospital mortality

Ofthe 4470 patients, 78.8% were males, and mean age was 55.52 ± 11 years. Intotal, 39.4% (1759) were found to have acute hyperglycemia and of these, 59%(1037) were already diagnosed with diabetes. Acute hyperglycemia was found tobe associated with female gender (25.1% vs. 18.9%; p<0.001), prolonged ischaemictime (380 [IQR: 260-520] vs. 355 [IQR: 240-495]; p<0.001), Killip classIII/IV at presentation (9.5% vs. 6.1%), hypertension (58.8% vs. 49%;p<0.001), obesity (18.4% vs. 15.9%; p=0.030) as compared to the patientswith RBS < 200mg/dl, respectively. On angiogram, patients with acute hyperglycemiahad higher pre-procedure LVEDP (22.29±10.27 vs. 21.33±9.66 mmHg; p<0.001),multi-vessel diseases (67% vs. 62%), and culprit RCA (32.1% vs. 29.9%).Patients with acute hyperglycemia were observed to have higher incidence ofheart failure (8.2% vs. 5.5%; p<0.001), CIN (10.9% vs. 7.4%; p<0.001),and in-hospital mortality (5.7% vs. 2.5%; p<0.001). On multivariableanalysis, acute hyperglycemia was found to be independent predictors ofmortality with an adjusted OR of 1.81 [95% CI: 1.28-2.55]. Multi-vessel disease(1.73 [95% CI: 1.17-2.56]), pre-procedure LVEDP (1.02 [95% CI: 1.0-1.03]), and Killipclass III/IV (4.55 [95% CI: 3.09-6.71]) were found to be the additionalindependent predictors of in-hospital mortality.

Theacute hyperglycemia, regardless of diabetic status, is found to be anindependent predictor of in-hospital mortality among patients with STE-ACS undergoingprimary PCI. Acute hyperglycemia, along with other significant predictors suchas multi-vessel involvement, LVEDP, and Killip class III/IV can be consideredfor the risk stratification of these patients.