title: Prognostic significance of HbA1c in patients with AMI treated invasively and newly detected glucose abnormalities.
abstract: BACKGROUND
  Glucose abnormalities are frequent comorbidities influencing prognosis in patients with cardiovascular diseases. The objective of this study was to evaluate prognostic role of HbA1c in patients with acute myocardial infarction (AMI) treated invasively, who had newly detected glucose abnormalities.
  
  
  METHODS
  Single-centre registry encompassed 2146 survivors of AMI. In all patients without diabetes mellitus (DM), oral glucose tolerance test was performed before hospital discharge and interpreted according to the guidelines.
  
  
  METHODS
  From the study population, two major groups with defined new glucose abnormalities and estimated HbA1c were selected: 457 patients with impaired glucose tolerance (IGT) and 306 patients with newly detected DM (newDM). In each of these groups, the median value of HbA1c was calculated and established as the cut-off point for further analysis. The median HbA1c for IGT group was 5.9% and for newDM was 7.0%.
  
  
  RESULTS
  Patients with IGT and HbA1c ≤ 5.9% had significantly lower posthospital mortality (4.5%) than those with HbA1c >5.9% (25.0%; p<0.001). Similarly, patients with newDM and HbA1c ≤7.0% had lower mortality (6.4%) than those with HbA1c >7.0% (14.3%; p<0.05). Multivariate regression analysis revealed that increase of HbA1c was one of the strongest independent risk factors of death among IGT patients (HR 2.9, 95% CI 2.7-3.1; p < 0.001) and newDM (HR 1.53, 95% CI 1.39-1.66; p<0.05).
  
  
  CONCLUSIONS
  Increase of HbA1c in patients with newly detected glucose abnormalities was associated with significantly reduced survival after AMI treated invasively. Moreover, increase of HbA1c in patients with IGT and newDM was one of the strongest independent risk factors of death in these populations.
authors.affiliation: Medical University of Silesia, Zabrze, Poland jacekmed@yahoo.com.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kowalczyk
authors.affiliation: Medical University of Silesia, Zabrze, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Mazurek
authors.affiliation: Medical University of Silesia, Zabrze, Poland.
authors.forename: Teresa
authors.initials: T
authors.lastname: Zielinska
authors.affiliation: Medical University of Silesia, Zabrze, Poland.
authors.forename: Radoslaw
authors.initials: R
authors.lastname: Lenarczyk
authors.affiliation: Medical University of Silesia, Zabrze, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Sedkowska
authors.affiliation: Medical University of Silesia, Zabrze, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Swiatkowski
authors.affiliation: Medical University of Silesia, Zabrze, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Sredniawa
authors.affiliation: Medical University of Silesia, Zabrze, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Mencel
authors.affiliation: Medical University of Silesia, Zabrze, Poland.
authors.forename: Pawel
authors.initials: P
authors.lastname: Francuz
authors.affiliation: Medical University of Silesia, Zabrze, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D018149:Glucose Intolerance / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011044:Poland / Q000453:epidemiology; D011237:Predictive Value of Tests; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Acute myocardial infarction; HbA1c; diabetes mellitus; impaired glucose tolerance; percutaneous coronary intervention