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HbA1c/C-peptide ratio is associated with angiographic thrombus burden and short-term mortality in patients presenting
Kenan Toprak1, Mustafa Kaplangöray2, Tolga Memioğlu3
1Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa.
Insights
The HbA1c/C-peptide ratio (HCR) effectively predicts high thrombus burden and short-term mortality in ST-elevation myocardial infarction (STEMI) patients. This combined biomarker offers superior predictive value compared to individual markers for cardiovascular events.
Area of Science:
- Cardiology
- Biomarker Research
- Clinical Medicine
Background:
- High thrombus burden (HTB) in ST-elevation myocardial infarction (STEMI) correlates with adverse cardiovascular outcomes.
- HbA1c (glycated hemoglobin) has prothrombotic effects, while C-peptide exhibits antithrombotic properties.
- Understanding the interplay of these markers is crucial for risk stratification in STEMI.
Purpose of the Study:
- To evaluate the predictive value of the HbA1c/C-peptide ratio (HCR) for angiographic high thrombus burden (HTB) in STEMI patients.
- To assess the association between HCR and short-term mortality following STEMI.
- To compare the predictive efficacy of HCR against individual HbA1c and C-peptide levels.
Main Methods:
- Retrospective analysis of 1202 STEMI patients undergoing primary percutaneous coronary intervention (pPCI).
- Patients categorized into thrombus burden (TB) groups.
- Comparison of clinical demographics, laboratory parameters, and HbA1c/C-peptide ratios (HCR) across groups.
Main Results:
- HCR values were significantly higher in the HTB group compared to the low thrombus burden (LTB) group (3.5 ± 1.2 vs. 2.0 ± 1.1, P < 0.001).
- Multivariable analysis identified HCR as an independent predictor of HTB (OR: 2.377, P < 0.001) and short-term mortality.
- Receiver operating characteristic (ROC) analysis showed HCR predicted HTB with 73% sensitivity and 72% specificity, outperforming HbA1c and C-peptide alone.
Conclusions:
- The HbA1c/C-peptide ratio (HCR) is a significant predictor of high thrombus burden in STEMI patients.
- HCR is also strongly associated with increased short-term mortality in this patient population.
- Combining HbA1c and C-peptide into a single ratio provides enhanced predictive value for adverse outcomes in STEMI.
Objectives:
Angiographic high thrombus burden (HTB) is associated with increased adverse cardiovascular events in patients with ST-elevation myocardial infarction (STEMI). HbA1c and C-peptide are two interrelated bioactive markers that affect many cardiovascular pathways. HbA1c exhibits prothrombogenic properties, while C-peptide, in contrast, exhibits antithrombogenic effects. In this study, we aimed to demonstrate the value of combining these two biomarkers in a single fraction in predicting HTB and short-term mortality in patients with STEMI.
Methods:
1202 patients who underwent primary percutaneous coronary intervention (pPCI) for STEMI were retrospectively included in this study. The study population was divided into thrombus burden (TB) groups and compared in terms of basic clinical demographics, laboratory parameters and HbA1c/C-peptide ratios (HCR). In addition, short-term mortality of the study population was compared according to HCR and TB categories.
Results:
HCR values were significantly higher in the HTB group than in the LTB group (3.5 ± 1.2 vs. 2.0 ± 1.1; P < 0.001; respectively). In the multivariable regression analysis, HCR was determined as an independent predictor of HTB both as a continuous variable [odds ratio (OR): 2.377; confidence interval (CI): 2.090-2.704; P < 0.001] and as a categorical variable (OR: 5.492; CI: 4.115-7.331; P < 0.001). In the receiver operating characteristic (ROC) analysis, HCR predicted HTB with 73% sensitivity and 72% specificity, and furthermore, HCR's predictive value for HTB was superior to HbA1c and C-peptide. The Kaplan-Meier cumulative survival curve showed that short-term mortality increased at HTB. In addition, HCR strongly predicted short-term mortality in Cox regression analysis.
Conclusions:
In conclusion, HCR is closely associated with HTB and short-term mortality in STEMI patients.
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