Short-term mortality in acute coronary syndrome: effect of dysglycaemia and smoking

Coronary artery disease (CAD) is a major cause of morbidity and mortality burden in the developing world, including India 1. There is growing evidence that dysglycaemia, irrespective of the history of diabetes, is associated with adverse outcomes in coronary artery bypass graft surgery patients 2-4. Diabetes mellitus or impaired glucose tolerance, smoking or tobacco use in any form, not only predisposes to development of acute coronary syndrome (ACS) but also affects the long-term prognosis of the patients; however, their effect on short-term prognosis is not well assessed. Therefore, this study was planned to describe the potential effect of dysglycaemia and smoking on short-term mortality in patients with ACS. Short-term mortality data (during first week of acute coronary episode) of 364 patients with ACS were collected from the coronary care unit (CCU) of our hospital over a period of 7 months (January–July 2009). These cases were then analysed as regards to their smoking and dysglycaemic status. The fasting and 2 h postprandial blood glucose levels were used to assess the glycaemic status of the patients after the CCU admission. Out of 364 CAD patients, 144 (39.5%) patients were having dysglycaemia, and 86 (59.7%) of dysglycaemic patients were smokers. Mortality appears higher in the presence of both smoking and dysglycaemia, with potential gender differences in effects (see Table 1). Glycometabolic state at hospital admission is an important risk marker for mortality in patients with acute myocardial infarction, whether or not they have known diabetes mellitus. The presence of elevated blood glucose levels, diabetes mellitus or both contributes to more than 3 million cardiovascular deaths worldwide each year 5. Both acute phase hyperglycaemia (stress hyperglycaemia) and diabetes are associated with adverse outcomes in ACS 6, 7. Our descriptive data support the idea that dysglycaemia and smoking status potentially accounts for excess mortality. Both smoking and dysglycaemia are modifiable risk factors, which can be controlled by lifestyle modification in many patients. None.