Prevalence and impact on prognosis of glucometabolic states in acute coronary syndrome in a middle eastern country: The GLucometabolic abnOrmalities in patients with acute coronaRY syndrome in Jordan (GLORY) study

Western studies have shown that diabetes mellitus and other glucometabolic states are highly prevalent among patients with Acute Coronary Syndrome (ACS), and are associated with worse adverse cardiovascular outcome. Whether this also applies to Middle Eastern patients is largely unknown. We studied the prevalence of glucometabolic states (known diabetes, newly diagnosed diabetes, impaired fasting glucose (IFG), and no diabetes) in 656 ACS patients, who were followed up prospectively for total mortality, and composite events of death, readmission for myocardial infarction, or urgent coronary revascularization for 1 year after admission. Of the whole group, 291 (44.6%) were known diabetics, 69 (10.6%) had newly diagnosed diabetes, 86 (13.2%) had impaired fasting glucose, and 206 (31.6%) were nondiabetics. The overall in-hospital mortality rate was 2.6%, and was not significantly different between the four groups. At 1 year; overall mortality was 7.2%, and was significantly higher (p = 0.002) among diabetics (newly diagnosed; 17.1%, and known diabetics; 7.8%) compared with patients who had IFG (3.4%) and nondiabetics (4.4%). Composite events at 6 months was significantly higher (p = 0.016) in known diabetics (14.7%), compared with newly diagnosed diabetics (7.1%), IFG (9.2%) and nondiabetics (6.3%). At 1 year, composite events occurred in 15.9% of the whole group, and was significantly higher (p = 0.049) in known diabetics (20.1%), compared with newly diagnosed diabetics (10%), IFG (11.5%) and nondiabetics (13.6%). In Middle Eastern ACS patients, 70% have abnormal glucometabolic states. Newly diagnosed diabetics and known diabetics have higher risk of cardiovascular events than patients with impaired fasting glucose and nondiabetics after 1 year of admission.