Remedy Publications LLC. International Journal of Internal and Emergency Medicine 2020 | Volume 3 | Issue 1 | Article 1027 1 Effect of Glycated Hemoglobin A1C-Based Adjusted Glycemic Variables on the Outcome of Diabetic Patients Presenting with Acute Coronary Syndrome OPEN ACCESS *Correspondence: Maged Osama Aziz, Department of Emergency and Traumatology, Alexandria University, 9 Hefny Nasef Street, Sidi Gaber, Alexandria, Egypt, Tel: +201285565278; E-mail: maged_aziz@yahoo.com Received Date: 08 Apr 2020 Accepted Date: 24 Apr 2020 Published Date: 02 May 2020 Citation: Ghamin Y, Ayad M, Abdel Kareem A, Badra M, Alkafafy A, Osama Aziz M. Effect of Glycated Hemoglobin A1C- Based Adjusted Glycemic Variables on the Outcome of Diabetic Patients Presenting with Acute Coronary Syndrome. Int J Intern Emerg Med. 2020; 3(1): 1027. Copyright © 2020 Maged Osama Aziz. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Research Article Published: 02 May, 2020 Abstr act Background: Acute hyperglycemia is frequently used as a marker for predicting ACS adverse outcome in diabetic patients. In this study we suggest the introduction of a more accurate biomarker which could anticipate adverse outcome and length of hospital stay in ACS diabetic patients, the glycemic gap. Methods: Te 100 diabetic patients who were presented to ER with ACS were prospectively followed during their hospital stay. Admission blood glucose was measured and glycemic gap was calculated using the equation (28.7 × HbA1c − 46.7). Glycemic gap then correlated with MACE and hospital stay length. Results: Tere was a statistically signifcant relation between the glycemic gap value and MACE that the ACS patients with DM may witness during their hospital stay (p=0.001). Also there was a statistically signifcant relation between the glycemic gap value and the length of hospital stay of ACS patients with DM with p<0.001. In the analysis of the ROC curve for glycemic gap value to predict patient have complications, the optimal cutof value of the glycemic gap was 55 mg/dL, with maximum AUROC of 0.796 (95% CI=0.702-0.891) (sensitivity 86.11% and specifcity 56.25%) regarding complication occurrence. Conclusion: Glycemic gap could be used as a biomarker for predicting MACE and duration of hospital length in diabetic patients with ACS. Glycemic gap is a better marker than admission blood glucose alone in diabetic patient presented with ACS. Keywords: Hyperglycemia; Glycemic gap; Diabetes; Acute coronary syndrome; MACE Introduction Acute hyperglycemia is a common fnding in patients who attend the Emergency Department (ED) With Acute Coronary Syndrome (ACS) in both diabetic and non-diabetic patients. Te prognostic role of hyperglycemia in non-diabetic patients with (ACS) may be more well-established, but that role in diabetic patients remains controversial at least on the short term basis [1,2]. In diabetic patients hyperglycemia is the cardinal feature which may be noticed regardless of a stressful event due to many causes as poor glycemic control. So it is necessary to consider pre-existing hyperglycemia in diabetic patients when investigating the association between blood glucose level and adverse outcomes in patients with (ACS) or in other words- if hyperglycemia in this patient group will be used as a biomarker for predicting the outcome [3]. Te chronic efect of hyperglycemia is associated with long-term dysfunction, damage, and failure of various organs, especially the nerves, kidneys, eyes, heart, and blood vessels. In the development of diabetes, several pathogenic processes are involved. Tese may range from autoimmune destruction of the pancreatic β cells with consequent insulin defciency to abnormalities that result in resistance to insulin action [4]. Stress hyperglycemia is defned as a transient increase in blood glucose concentration during acute illness. It represents two distinct populations of patients: Tose with undiagnosed diabetes Yehia Ghamin 1 , Mona Ayad 2 , Abdel Kareem A 1 , Mai Badra 1 , Asmaa Alkafafy 3 and Maged Osama Aziz 3 * 1 Department of Internal Medicine, Alexandria University, Egypt 2 Department of Clinical and Chemical Pathology, Alexandria University, Egypt 3 Department of Emergency and Traumatology, Alexandria University, Egypt