Cardiovascular Journal of Africa: Vol 31 No 6 (November/December 2020)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 6, November/December 2020 AFRICA 319
Prognostic value of admission hyperglycaemia in black
Africans with acute coronary syndromes: a cross-
sectional study
Hermann Yao, Arnaud Ekou, Thierry Niamkey, Camille Touré, Charles Guenancia, Isabelle Kouamé,
Christelle Gbassi, Christophe Konin, Roland N’Guetta
Abstract
Aim: The aim of the study was to determine the relationship
between acute hyperglycaemia and in-hospital mortality in
black Africans with acute coronary syndromes (ACS).
Methods: From January 2002 to December 2017, 1 168
patients aged ≥ 18 years old, including 332 patients with
diabetes (28.4%), consecutively presented to the intensive care
unit of the Abidjan Heart Institute for ACS. Baseline data
and outcomes were compared in patients with and without
hyperglycaemia at admission (> 140 mg/dl; 7.8 mmol/l).
Predictors for death were determined by multivariate logistic
regression.
Results: The prevalence of admission hyperglycaemia was
40.6%. It was higher in patients with diabetes (55.3%). In
multivariate logistic regression, acute hyperglycaemia (hazard
ratio = 2.33; 1.44–3.77; p < 0.001), heart failure (HR = 2.22;
1.38–3.56; p = 0.001), reduced left ventricular ejection frac-
tion (HR = 6.41; 3.72–11.03; p < 0.001, sustained ventricular
tachycardia or ventricular fibrillation (HR = 3.43; 1.37–8.62;
p = 0.008) and cardiogenic shock (HR = 8.82; 4.38–17.76; p
< 0.001) were predictive factors associated with in-hospital
death. In sub-group analysis according to the history of
diabetes, hyperglycaemia at admission was a predictor for
death only in patients without diabetes (HR = 3.12; 1.72–5.68;
p < 0.001).
Conclusion: In ACS patients and particularly those without
a history of diabetes, admission acute hyperglycaemia was a
potentially threatening condition. Appropriate management,
follow up and screening for glucose metabolism disorders
should be implemented in these patients.
Keywords: hyperglycaemia, diabetes, acute coronary syndrome,
sub-Saharan Africa
Submitted 2/12/19, accepted 14/7/20
Published online 14/9/20
Cardiovasc J Afr 2020; 31: 319–324
DOI: 10.5830/CVJA-2020-028
Studies in the West have shown that elevation of blood glucose
is a common condition during the early phase of acute coronary
syndrome (ACS), even in the absence of a history of diabetes
mellitus (DM). 1-3 There is no uniform definition at present, but
the 140 mg/dl (7.8 mmol/l) threshold has often been considered.4
The prevalence of acute hyperglycaemia > 140 mg/dl ranged
from 39 to 58%.1,2,5
In addition to established prognostic factors (left ventricular
systolic dysfunction, heart failure, ventricular arrhythmias),6
acute elevation of blood glucose level was associated with
an increase in in-hospital stay, and 30-day and long-term
mortality rate, and there is evidence that the risk of mortality
is higher in patients without a history of DM.7-10 There is
a linear relationship between acute glycaemic levels and
outcomes.2,7 Pathophysiological mechanisms are uncertain, but
acute hyperglycaemia may be an epiphenomenon of the stress
response, or the trigger of complex underlying mechanisms,
leading to severe complications and poor outcomes.4,5
In sub-Saharan Africa, data on ACS are scarce,11,12
particularly on the prevalence and outcomes of patients with
acute hyperglycaemia. The aim of this study was to assess the
prognostic value of hyperglycaemia at admission in ACS patients
in our practice.
Methods
Our study was carried out at the Abidjan Heart Institute (Ivory
Coast). We conducted a cross-sectional, observational study
between 1 January 2002 and 31 December 2017, including
patients aged ≥ 18 years who presented to the intensive care
unit (ICU) of Abidjan Heart Institute for ACS. These patients
were divided into two groups according to their blood glucose
level at admission: admission hyperglycaemia (AH) (blood
glucose > 140 mg/dl; 7.8 mmol/l) and absence of admission
hyperglycaemia (NAH) (blood glucose ≤ 140 mg/dl).4 The
blood glucose level considered was the first venous plasma
glucose level obtained at admission or within the first 24 hours,
and before any glucose-lowering therapy was given during
hospitalisation.
The exclusion criteria were: ACS patients with incomplete
medical records or who declined to participate in the study,
patients with suspected ACS in whom the clinical course and
Abidjan Heart Institute, Abidjan, Ivory Coast
Hermann Yao, MD,
Arnaud Ekou, MD
Thierry Niamkey, MD
Camille Touré, MD
Isabelle Kouamé, MD
Christelle Gbassi, MD
Christophe Konin, MD
Roland N’Guetta, MD
Cardiology Department, Dijon University Teaching
Hospital, Dijon, France
Charles Guenancia, MD, PhD