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Haemoglobin A 1c , acute hyperglycaemia and short‐term prognosis in patients without diabetes following acute ST‐segment elevation myocardial infarction
Author(s) -
Liu Y.,
Yang Y.M.,
Zhu J.,
Tan H.Q.,
Liang Y.,
Li J.D.
Publication year - 2012
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2012.03641.x
Subject(s) - medicine , myocardial infarction , diabetes mellitus , cardiology , term (time) , elevation (ballistics) , st elevation , acute st segment elevation myocardial infarction , percutaneous coronary intervention , endocrinology , physics , geometry , mathematics , quantum mechanics
Diabet. Med. 29, 1493–1500 (2012) Abstract Aims To assess the prognostic impact of HbA 1c and blood glucose level in patients with acute ST‐segment elevation myocardial infarction and without diabetes. The relationship between HbA 1c and acute hyperglycaemia was also explored. Methods and results We evaluated 4793 ST‐segment elevation myocardial infarction patients with baseline HbA 1c and three glucose measurements in the first 24 h. First, patients were stratified into quintiles by HbA 1c and mean/admission glucose level. A total of 373 deaths (7.8%) occurred at 7 days, and 486 deaths (10.1%) occurred at 30 days. There were no significant differences in 7‐ and 30‐day mortality, and major adverse cardiovascular event rates across HbA 1c quintiles (< 34.4 mmol/mol (5.3% ), 34.4 to < 37.7 mmol/mol (5.6%), 37.7 to < 41.0 mmol/mol (5.9% ), 41.0 to < 47.5 mmol/mol (6.5%), and ≥ 47.5 mmol/mol; P for trend > 0.05). The risks of mortality and major adverse cardiovascular events were significantly increased in patients with higher glucose quintiles and lower quintile compared with the middle quintile after multivariable adjustment ( P < 0.001). Patients were then reclassified into four groups according to mean/admission glucose and HbA 1c levels. The group with elevated glucose and non‐elevated HbA 1c was associated with the highest mortality and major adverse cardiovascular event risk ( P < 0.001). Conclusions Unlike acute hyperglycaemia, an elevated HbA 1c level was not a risk factor for short‐term outcomes in ST‐segment elevation myocardial infarction patients without diabetes. Patients with acute hyperglycaemia and non‐elevated HbA 1c were associated with the worst prognosis. That suggests chronic glycaemic control/HbA 1c level may help to recognize stress‐induced hyperglycaemia and identify high‐risk patients.