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Diabet. Med. 29, 1493–1500 (2012)

Abstract

Aims  To assess the prognostic impact of HbA1c and blood glucose level in patients with acute ST-segment elevation myocardial infarction and without diabetes. The relationship between HbA1c and acute hyperglycaemia was also explored.

Methods and results  We evaluated 4793 ST-segment elevation myocardial infarction patients with baseline HbA1c and three glucose measurements in the first 24 h. First, patients were stratified into quintiles by HbA1c 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 HbA1c 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 HbA1c levels. The group with elevated glucose and non-elevated HbA1c was associated with the highest mortality and major adverse cardiovascular event risk (P < 0.001).

Conclusions  Unlike acute hyperglycaemia, an elevated HbA1c 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 HbA1c were associated with the worst prognosis. That suggests chronic glycaemic control/HbA1c level may help to recognize stress-induced hyperglycaemia and identify high-risk patients.