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Frequent fluctuations of hemoglobin A1c (HbA 1C ) values predict patient outcomes. However, data regarding prognoses depending on the long-term changes in HbA 1C among patients after acute myocardial infarction (AMI) are scarce. We evaluated the prognostic significance of HbA 1C levels and changes among diabetic patients ( n = 4066) after non-fatal AMI. All the results of HbA 1C tests up to the 10-year follow-up were obtained. The changes (∆) of HbA 1C were calculated in each patient. The time intervals of ∆HbA 1C values were classified as rapid (&lt;one year) and slow (≥one year) changes. The outcome was all-cause mortality. The highest mortality rates of 53.8% and 35.5% were found in the HbA 1C &lt; 5.5-7% and ∆HbA 1C = -2.5-(-2%) categories. A U-shaped association was observed between HbA 1C and mortality: adjOR = 1.887 and adjOR = 1.302 for HbA 1C &lt; 5.5% and ≥8.0%, respectively, as compared with 5.5-6.5% ( p &lt; 0.001). Additionally, ∆HbA 1C was associated with the outcome (U-shaped): adjOR = 2.376 and adjOR = 1.340 for the groups of &lt;-2.5% and ≥2.5% ∆HbA 1C , respectively, as compared to minimal ∆HbA 1C (±0.5%) ( p &lt; 0.001). A rapid increase in HbA 1C (but not decrease) was associated with a greater risk of mortality. HbA 1C values and their changes are significant prognostic markers for long-term mortality among AMI-DM patients. ∆HbA 1C and its timing, in addition to absolute HbA 1C values, should be monitored.

journal of clinical medicine

Changes over Time in Hemoglobin A1C (HbA1C) Levels Predict Long-Term Survival Following Acute Myocardial Infarction among Patients with Diabetes Mellitus