title: Prognostic value of admission glycated haemoglobin in unknown diabetic patients with acute myocardial infarction.
abstract: BACKGROUND
  Acute glycometabolic derangement in non-diabetic patients with acute myocardial infarction (AMI) has been reported with discrepant prognostic results. The aim of the present study was to assess the prognostic impact of glycated haemoglobin (HbA1c) levels, reflecting long-term glycometabolic disturbance, in a population of patients without known diabetes mellitus.
  
  
  METHODS
  We examined 601 consecutive prospective patients diagnosed with AMI and unknown diabetes mellitus. We analysed metabolic function as a stratified variable using three groups of patients according to HbA1c: Group 1 (< 5.5%): 222 patients (37%); Group 2 (5.5 to 6.4%): 337 patients (56%); Group 3 (>6.4%): 42 patients (7%). Association between HbA1c groups and classic cardiovascular risk factor and in-hospital outcomes were assessed through univariate and multivariate analysis.
  
  
  RESULTS
  In-hospital mortality was 5% (32/601 patients). Higher HbA1c was associated with poor glycometabolic control, older patients, obesity, hypertension, Killip's class>1, increased heart rate, initial bundle branch block, atrial fibrillation and higher mortality during follow-up. In a multivariate adjusted risk, in-hospital mortality was associated with age (odds ratio (OR)= 1.056; 1-1.1; p=0.006), Killip's class>1 (OR=2.4; 1-6.1; p=0.05) and HbA1c (OR=1.5; 1.15-1.9; p=0.002). Hypertension (OR=0.39; 0.18-0.87; p=0.022) and angiotensin-converting enzyme inhibitors (OR=0.28; 0.12-0.69; p=0.005) were protective factors.
  
  
  CONCLUSIONS
  HbA1c is an important risk marker in the absence of a history of diabetes mellitus in patients with AMI. The optimal management strategy in these patients may contribute to decreased in-hospital mortality.
authors.affiliation: Coronary Care Unit, University Clinic Hospital of Valencia, Spain blasco_luicor@gva.es.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Blasco
authors.affiliation: Coronary Care Unit, University Clinic Hospital of Valencia, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Sanjuan
authors.affiliation: Coronary Care Unit, University Clinic Hospital of Valencia, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: Palacios
authors.affiliation: Coronary Care Unit, University Clinic Hospital of Valencia, Spain.
authors.forename: Rotzel
authors.initials: R
authors.lastname: Huerta
authors.affiliation: Service of Clinical Chemistry, University Clinic Hospital of Valencia, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Carratala
authors.affiliation: Haemodynamic Unit, University Clinic Hospital of Valencia, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Nuñez
authors.affiliation: Haemodynamic Unit, University Clinic Hospital of Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
mesh_terms: D000704:Analysis of Variance; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D058065:Diabetic Cardiomyopathies / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D006442:Glycated Hemoglobin
keywords: Acute myocardial infarction; admission glycaemia; diabetes mellitus; glycated haemoglobin (HbA1c)