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Hemoglobin A1c and short-term outcomes in patients with acute myocardial infarction undergoing primary angioplasty:
Li Tian1, Jun Zhu, Lisheng Liu
1State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Insights
Admission hemoglobin A1c (HbA1c) levels do not predict short-term outcomes in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). This study found no significant differences in mortality or major adverse cardiac events between different HbA1c groups.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Research
Background:
- Admission hemoglobin A1c (HbA1c) levels are increasingly studied for their prognostic value in acute myocardial infarction (AMI).
- Previous research on HbA1c and outcomes in patients with AMI treated with primary percutaneous coronary intervention (PCI) has yielded inconsistent results.
- The correlation between admission HbA1c and short-term outcomes in ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI requires further clarification.
Purpose of the Study:
- To investigate the association between admission hemoglobin A1c (HbA1c) levels and short-term clinical outcomes in patients with ST-elevation myocardial infarction (STEMI).
- To determine if HbA1c levels can serve as an independent prognostic marker for patients undergoing primary percutaneous coronary intervention (PCI).
Main Methods:
- An observational multicenter study enrolled 608 patients with STEMI undergoing primary PCI.
- Patients were stratified into three groups based on admission HbA1c levels: ≤5.6%, 5.7-6.4%, and ≥6.5%.
- Primary outcomes included all-cause mortality and major adverse cardiac events (MACE) assessed at 7 and 30 days post-admission.
Main Results:
- No significant differences in 7-day or 30-day mortality were observed among the three HbA1c groups (P=0.179 and P=0.241, respectively).
- Major adverse cardiac events (MACE), target vessel revascularization, and rehospitalization rates were similar across all HbA1c strata at 7 and 30 days.
- After adjusting for baseline characteristics, admission HbA1c was not found to be an independent predictor of short-term outcomes in STEMI patients (HR: 0.431; 95% CI: 0.175-1.061; P=0.067).
Conclusions:
- Admission hemoglobin A1c (HbA1c) levels do not appear to be an independent prognostic marker for short-term outcomes in ST-elevation myocardial infarction (STEMI) patients treated with primary PCI.
- The study suggests that other factors may be more critical in predicting short-term prognosis for this patient population.
Objective:
Several studies to date have examined whether admission levels of hemoglobin A1c (HbA1c) correlate with short-term and long-term outcomes in patients with acute myocardial infarction treated with primary percutaneous coronary intervention (PCI). However, the results have been ambiguous. We speculated that admission levels of HbA1c correlate with short-term outcomes of patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI.
Methods:
In this observational multicenter study, 608 patients with STEMI who underwent primary PCI between June 2001 and July 2004 were enrolled. Blood samples were collected upon admission to hospital for HbA1c measurement. Follow-up was carried out at 7 and 30 days after hospital admission. According to the new American Diabetes Association criteria, patients were stratified into three groups: I, HbA1c 5.6% or less (n=262); II, HbA1c 5.7-6.4% (n=182); and III, HbA1c at least 6.5% (n=164). The primary outcomes were all-cause mortality and major adverse cardiac events at follow-up.
Results:
The 7-day mortality was similar (P=0.179) between groups I (1.9%), II (2.2%), and III (0.0%); the 30-day mortality was also similar (P=0.241) between groups I (3.8%), II (2.2%), and III (1.2%). MACE at the 7- day and 30-day follow-up were not significantly different between the three groups either (P>0.05). Rates of target vessel revascularization and rehospitalization, and MACE-free survival curves, at the 30-day follow-up were also similar among the three groups. After adjusting the baseline characteristics, HbA1c was not an independent predictor of short-term outcomes (hazards ratio: 0.431; 95% confidence interval: 0.175-1.061, P=0.067).
Conclusion:
Admission levels of HbA1c are not an independent prognostic marker for short-term outcomes in STEMI patients treated with primary PCI.
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