title: Haemoglobin A(1c) , acute hyperglycaemia and short-term prognosis in patients without diabetes following acute ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Liu
authors.forename: Y-M
authors.initials: YM
authors.lastname: Yang
authors.forename: J
authors.initials: J
authors.lastname: Zhu
authors.forename: H-Q
authors.initials: HQ
authors.lastname: Tan
authors.forename: Y
authors.initials: Y
authors.lastname: Liang
authors.forename: J-D
authors.initials: JD
authors.lastname: Li
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002681:China / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human