Sasikumar, B (2008) Stress Hyperglycemia - An independent risk factor for multivessel coronary artery disease in Post Myocardial Infarction Patients. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION : Diabetes Mellitus (DM) is an established major cardio vascular risk factor associated with increased prevalence of coronary artery disease. Patients with diabetes mellitus have higher incidence of acute myocardial infarction and congestive cardiac failure. Poor glycemic control and insulin resistance are associated with significant endothelial cell dysfunction, procoagulability and diffuse multi vessel disease. Individuals with diabetes mellitus who have acute myocardial infarction (AMI) have higher mortality than those without diabetes. The significance of hyperglycemia observed after AMI has stimulated renewed interest. In recent years attention has been given to the evidence that the concomitant occurrence of hyperglycemia in patients admitted to intensive care units with an AMI enhance the risk of mortality and morbidity whether the patient has diabetes mellitus or not. Among patients with no prior history of diabetes, hyperglycemia may reflect previously diagnosed diabetes mellitus, preexisting carbohydrate intolerance, stress related carbohydrate intolerance, or a combination of these. Glycometabolic state at hospital admission is an important risk marker for long term mortality in patients with AMI whether or not they have diabetes mellitus. Hyperglycemia occurring at admission in patients with suspected acute myocardial infarction generally represents stress hyperglycemia. The amount by which a patient’s plasma glucose concentration increases during the early course of an AMI is determined by the levels of catecholamines and cortisol, which are in turn related to the infarct size, and degree of myocardial dysfunction. AIM OF THE STUDY : High admission plasma glucose levels after acute myocardial infarction are common and associated with an increased risk of death in subjects with and without known diabetes mellitus. Recent data indicates a high prevalence of abnormal glucose metabolism with nondiabetic patients at the time of AMI. We investigated the predictive value of stress hyperglycemia after AMI, for the extent of coronary artery disease(CAD) in patients with or without diabetes, particularly in those without preexisting diabetes but with impaired glucose tolerance during acute myocardial infarction and reverting to normal values after one month of post MI period. Objectives: 1. To assess the incidence of stress hyperglycemia in patients with AMI in non-diabetic patients. 2. To compare the severity of coronary artery disease in patients, with stress hyperglycemia to those with normal glucose tolerance, and those known to have diabetes mellitus, in the setting of acute myocardial infarction. CONCLUSION : The present study provides further evidence to support the previous finding that stress hyperglycemia is common in AMI in non diabetic patients. This study also suggests that the severe coronary artery disease is present not only in the diabetes groups but also in the stress hyperglycemia group. Our study demonstrates an additional aspect of how stress hyperglycemia contributes to poor outcome in MI patients with or without diabetes. Stress hyperglycemia is an early simple and inexpensive marker of severe coronary artery disease in patients with AMI. Hence an oral glucose tolerance test can easily be added to the standard risk evaluation procedures in patients with acute myocardial infarction and may be of value for enhanced secondary prevention.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Stress Hyperglycemia ; Multivessel Coronary Artery Disease ; Post Myocardial Infarction Patients. |
| Subjects: | MEDICAL > Cardiology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 10 Jul 2017 22:18 |
| Last Modified: | 10 Jul 2017 22:18 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1349 |
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