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Hemoglobin A1c is a better predictor of prognosis following the non-ST elevation acute coronary syndrome than fasting and admission glucose

Hämoglobin A1c ist ein besserer Prädiktor der Prognose nach einem akuten Koronarsyndrom ohne ST-Hebung als die Nüchtern- und Einlieferungsglukose

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Summary

Background

Glucometabolic status is an important predictor of prognosis in patients with acute myocardial infarction. Both plasma glucose levels and glycosylated hemoglobin A1c (HbA1c) were implicated as predictors of prognosis. However, previous data yielded conflicting results. We evaluated the prognostic role of plasma glucose levels and HbA1c in patients with non-ST elevation acute coronary syndrome (NSTEACS).

Methods

A total of 106 consecutive patients with NSTEACS (55 with unstable angina and 51 with non-ST elevation myocardial infarction) were included. The average age was 66.1 years; 61 % were male. HbA1c was measured at admission, along with other standard laboratory values. The follow-up period lasted for a year. The main combined outcome variable included death from cardiovascular causes and rehospitalization due to another acute coronary syndrome or due to heart failure.

Results

Combined end point occurred in 43 (41 %) patients. Mean HbA1c value was significantly higher in the group of patients who had complications (7.6 ± 2.6 vs. 5.8 ± 1.2, p < 0.05). Logistic regression identified HbA1c [odds ratio (OR): 1.6] and male sex (OR: 0.25) as the only independent predictors of major adverse cardiac events (MACE). A Kaplan–Meier analysis showed a 2.7 times higher risk of MACE in patients with HbA1c > 6.5 %.

Conclusions

Results from our study indicate that the admission level of HbA1c, but not admission or fasting glucose, is a predictor of mortality and major adverse events in patients with NSTEACS. These results identify HbA1c to be an independent predictor also in patients with NSTEACS, and not only in those with ST elevation myocardial infarction as observed before our study.

Zusammenfassung

Grundlagen

Glukosemetabolismus ist ein wichtiger Prädiktor für die Prognose bei Patienten mit akutem Herzinfarkt (AMI). Die Plasma Glucose-Konzentration sowie glykosyliertes Hämoglobin (HbA1c) waren Prädiktoren für die Prognose. Vorherige Daten brachten aber widersprüchliche Ergebnisse. Wir untersuchten die prognostische Rolle der Plasma Glucose-Konzentrationen und HbA1c bei Patienten mit akutem Koronarsyndrom ohne ST-Hebungen (NSTEACS).

Methodik

106 Patienten mit NSTEACS (55 mit instabiler Angina und 51 mit Nicht-ST-Hebungsinfarkt) wurden im prospektiven Design inkludiert. Das durchschnittliche Alter war 66,1 Jahre, 61 % waren Männer. HbA1c wurde bei der Einlieferung gemessen, gemeinsam mit den anderen Standardlaborwerten. Die Nachbeobachtungszeit dauerte ein Jahr. Die Zielvariable schließt Tod durch kardiovaskulare Ursachen und Rehospitalisierung wegen eines anderen akuten Koronarsyndroms oder wegen der Herzinsuffizienz ein (Major Adverse Cardiac Events – MACE).

Ergebnisse

Der kombinierte Endpunkt erschien bei 43 (41 %) Patienten. Der durchschnittliche HbA1c-Wert war deutlich höher bei der Gruppe der Patienten mit Störungen (7,6 ± 2,6 vs. 5,8 ± 1,2, p < 0,05). Die logistische Regression identifizierte nur HbA1c (OR 1,6) und das männliche Geschlecht (OR 0,25) als unabhängige Prädiktoren des MACE. Die Kaplan-Meier-Analyse zeigte ein 2,7 mal höheres MACE-Risiko bei Patienten mit HbA1c > 6,5 %.

Schlussfolgerungen

Die Ergebnisse unserer Studie zeigen, dass nur HbA1c zum Zeitpunkt der klinischen Aufnahme und nicht die Nüchternglukose-Konzentration ein Prädiktor für die Mortalität und MACE bei Patienten mit NSTEACS ist. Diese Ergebnisse erweitern frühere Beobachtungen über den prognostischen Wert von HbA1c bei Patienten mit ST-Hebungsinfarkt auf die NSTEACS-Gruppe.

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Conflict of interest

The authors have no conflict of interest to declare nor financial relationships to disclose.

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Authors and Affiliations

  1. Medical Intensive Care Unit, Novo mesto General Hospital, Novo mesto, Slovenia

    Marko Kmet MD

  2. University of Ljubljana, Ljubljana, Slovenia

    Borut Rajer BSc

  3. Cardiology Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia

    Andrej Pernat MD, PhD

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  1. Marko Kmet MD
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  2. Borut Rajer BSc
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Correspondence to Andrej Pernat MD, PhD.

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Kmet, M., Rajer, B. & Pernat, A. Hemoglobin A1c is a better predictor of prognosis following the non-ST elevation acute coronary syndrome than fasting and admission glucose. Wien Klin Wochenschr 126, 156–162 (2014). https://doi.org/10.1007/s00508-013-0468-2

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