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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 6, November/December 2020
AFRICA
321
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 the risk factors associated with in-hospital
death. PCI (HR
=
0.35; 0.16–0.79;
p
=
0.01) and dyslipidaemia
(HR
=
0.48; 0.27–0.84;
p
=
0.01) were identified as protective
factors (Tables 2, 3).
The sub-group analyses according to the history of DM
emphasised cardiogenic shock (HR
=
23.75; 7.60–74.27;
p
<
0.001 and HR
=
9.05; 3.66–22.33;
p
<
0.001, respectively) in
both AH and NAH populations as risk factors (Tables 4, 5).
In patients without a history of DM, only hyperglycaemia was
associated with in-hospital death (HR
=
3.12; 1.72–5.68;
p
<
0.001) (Table 5).
We carried out a second analysis over two periods: 2002–2010
and 2011–2017. Admission hyperglycaemia was a predictive
factor only from 2011–2017 (HR
=
2.57; 1.52–4.32). (Tables 6, 7).
The blood glucose threshold of 151 mg/dl (8.38 mmol/l) was
the one with the best sensitivity and specificity (area under the
curve
=
0.636; sensitivity 61%, specificity 67%;
p
<
0.001) (Fig. 1).
Considering the value of 140 mg/dl (7.8 mmol/l), we found similar
sensitivity and specificity (sensitivity 62%, specificity 60%).
Discussion
Whereas estimation of the prevalence of DM in ACS
patients is known in sub-Saharan Africa, ranging from 25
Table 1. Patient characteristics according to
glycaemia status at admission
Characteristics
AH
n
=
474
NAH
n
=
694
p
-value
Age (years), m
±
SD
57.9
±
11.0
54.7
±
11.8
<
0.001
Age
>
60 years
193 (40.7)
220 (31.7)
0.001
Female gender
42 (19.8)
94 (15.1)
0.10
Hypertension
312 (65.8)
377 (54.3)
<
0.001
Diabete mellitus
262 (55.3)
70 (10.1)
<
0.001
Active smoking
113 (23.8)
222 (32.0)
0.002
Dyslipidaemia
149 (31.4)
216 (31.1)
0.91
Familial history of CAD
27 (5.7)
44 (6.3)
0.65
History of MI
42 (8.9)
58 (8.4)
0.76
History of stroke
24 (5.1)
23 (3.3)
0.13
Admission delay (hours), m (IQR)
15 (5–52)
20 (5–48)
0.37
Systolic BP (mmHg), m
±
SD
148.8
±
34.3
143.5
±
29.1
0.01
Diastolic BP (mmHg), m
±
SD 92.1
±
21.2
88.1
±
19.0
<
0.001
Heart rate (bpm), m
±
SD
89.4
±
20.9
81.8
±
18.8
<
0.001
Congestive heart failure
168 (35.4)
144 (20.7)
<
0.001
LVEF
<
40%
210 (44.3)
198 (28.5)
<
0.001
ECG findings
0.005
Anterior ACS
274 (57.8)
321 (63.6)
Inferior ACS
169 (35.7)
315 (45.4)
Lateral ACS
31 (6.5)
58 (8.4)
Troponine Ic peak (µg/l), m (IQR)
13.1 (5.2–30.0)
4.9 (1.4–15.0)
0.004
CPK peak (UI/l), m (IQR)
1083 (436–2680) 714 (245–1900)
<
0.001
CKMB peak (UI/l), m (IQR)
91 (40–242)
65 (26–171)
<
0.001
STEMI
369 (77.8)
431 (62.1)
<
0.001
Atrial fibrillation
16 (3.4)
22 (3.2)
0.84
SVT/VF
18 (3.8)
25 (3.6)
0.86
Cardiogenic shock
31 (6.5)
20 (2.9)
0.002
PCI
81 (17.1)
139 (20.1)
0.21
DAPT
455 (65.6)
327 (69.0)
0.22
Death
72 (15.2)
34 (4.9)
<
0.001
Length of stay (days), m
±
SD
9.0
±
5.9
8.4
±
5.3
0.03
Severity of CAD
n
=
144
n
=
420
0.51
Non significant CAD
23 (16.0)
59 (14.0)
1-vessel CAD
48 (34.0)
162 (38.6)
2-vessel CAD
44 (30.6)
135 (32.1)
3-vessel CAD
28 (19.4)
64 (15.2)
Data are in
n
(%), means
±
standard deviation or median (interquartile range).
AH: admission hyperglycaemia. NAH: absence of admission hyperglycaemia.
CAD: coronary artery disease. BP: blood pressure. MI: myocardial infarction.
LVEF: left ventricular ejection fraction. STEMI: ST-segment elevation myocar-
dial infarction. SVT/VF: sustained ventricular tachycardia/ventricular fibrillation.
DAPT: dual antiplatelet therapy. PCI: percutaneous coronary intervention.
Table 2. Predictors of in-hospital death. Univariate analysis
Predictors
Alive at
discharge (
n
=
1062)
Death during
hospitaliza-
tion
(
n
=
106) HR 95% CI
p
-value
Age
>
60 years
361 (34.0) 52 (49.1) 1.87 1.25–2.79 0.002
Female gender
195 (18.4) 30 (28.3) 1.75 1.12–2.75 0.01
Hypertension
619 (58.3) 70 (66.0) 1.39 0.91–2.12 0.12
Diabete mellitus
288 (27.1) 44 (41.5) 1.91 1.27–2.87 0.002
Active smoking
313 (29.5) 22 (20.8) 0.63 0.38–1.02 0.06
Dyslipidaemia
342 (32.2) 23 (21.7) 0.58 0.36–0.94 0.03
History of MI
92 (8.7)
8 (7.5)
0.86 0.40–1.82 0.69
Admission delay (hours),
m (IQR)
18 (5–48) 25 (6–72)
–
–
0.02
Congestive heart failure
249 (23.4) 63 (59.4) 4.78 3.17–7.23
<
0.001
LVEF
<
40%
322 (30.3) 86 (81.1) 9.88 5.97–16.36
<
0.001
Anterior ACS
527 (49.6) 68 (64.2) 1.82 1.20–2.75 0.004
Admission hyperglycaemia 402 (37.9) 72 (67.9) 3.48 2.27–5.32
<
0.001
STEMI
707 (66.6) 93 (87.7) 3.59 1.98–6.51 0.01
Atrial fibrillation
35 (3.3)
3 (2.8)
0.85 0.26–2.83 0.54
SVT/VF
33 (3.1)
10 (9.4)
3.24 1.55–6.79
<
0.001
Cardiogenic shock
23 (2.2)
28 (26.4) 16.22 8.92–29.48
<
0.001
DAPT
716 (67.4) 66 (62.3) 0.80 0.53–1.21 0.28
PCI
212 (20.0)
8 (7.5)
0.32 0.16–0.68 0.002
Data are in
n
(%) or median (interquartile range). HR: hazard ratio. 95% CI: 95%
confidence interval. MI: myocardial infarction. LVEF: left ventricular ejection
fraction. ACS: acute coronary syndrome. STEMI: ST-segment elevation myocar-
dial infarction. SVT/VF: sustained ventricular tachycardia/ventricular fibrillation.
DAPT: dual antiplatelet therapy. PCI: percutaneous coronary intervention.
Table 3. Predictors of in-hospital death. Multivariate analysis
Predictors
Initial model
Final model
HR 95% CI
p
-value HR 95% CI
p
-value
Age
>
60 years
1.60 0.95–2.70 0.07
Female gender
0.84 0.47–1.51 0.57
Hypertension
0.88 0.51–1.52 0.65
Diabetes mellitus
1.50 0.85–2.64 0.15
Active smoking
0.53 0.27–1.05 0.57
Dyslipidaemia
0.58 0.32–1.05 0.07 0.48 0.27–0.84 0.01
Admission delay (hours),
m (IQR)
1.00 0.99–1.01 0.18
Congestive heart failure
2.25 1.34–3.75 0.002 2.22 1.38–3.56 0.001
LVEF
<
40%
6.02 3.37–10.77
<
0.001 6.41 3.72–11.03
<
0.001
Anterior ACS
1.35 0.78–2.35 0.28
Admission hyperglycaemia 1.76 1.00–3.09 0.05 2.33 1.44–3.77
<
0.001
STEMI
1.75 0.83–3.69 0.14
SVT/VF
3.97 1.47–10.74 0.007 3.43 1.37–8.62 0.008
Cardiogenic shock
12.32 5.71–26.58
<
0.001 8.82 4.38–17.76
<
0.001
PCI
0.32 0.13–0.80 0.02 0.35 0.16–0.79 0.01
HR: hazard ratio. 95% CI: 95% confidence interval. MI: myocardial infarction.
LVEF: left ventricular ejection fraction. ACS: acute coronary syndrome. STEMI:
ST-segment elevation myocardial infarction. SVT/VF: sustained ventricular tachy-
cardia/ventricular fibrillation. PCI: percutaneous coronary intervention.