Clinical influence of early follow-up glycosylated hemoglobin levels on cardiovascular outcomes in diabetic patients with ST-segment elevation myocardial infarction after coronary reperfusion.
OBJECTIVE
Recent studies have shown continuous control of diabetes is important for favorable outcomes in patients with ST-segment elevation myocardial infarction (STEMI). This study aimed to evaluate the clinical influence of postprocedural glycosylated hemoglobin A1c (HbA1c) levels on major adverse cardiac events (MACE) in diabetic patients with STEMI after coronary reperfusion.


METHODS
A total of 303 patients with diabetes and STEMI undergoing a primary percutaneous coronary intervention were enrolled in this study. All eligible patients were divided into the following three groups on the basis of follow-up HbA1c (FU-HbA1c) levels, which were measured at a median of 85 days after the procedure: optimal, FU-HbA1c<7%; suboptimal, 7%≤FU-HbA1c<9%; and poor, FU-HbA1c≥9%. We analyzed the 12-month cumulative MACE, defined as mortality, nonfatal myocardial infarction, and revascularization. In addition, we investigated FU-HbA1c levels as a predictor of MACE.


RESULTS
The incidence rates of MACE differed significantly between groups (6.4 vs. 13.6 vs. 19.6%; P=0.048). Moreover, the risk was increased in each successive group (hazard ratio: 1.00 vs. 2.19 vs. 3.68; P=0.046). Each 1% increase in the FU-HbA1c level posed a 26.6% relative increased risk of MACE (P=0.031). The optimal cutoff value for FU-HbA1c in predicting MACE was 7.45%.


CONCLUSIONS
This study showed that higher levels of early FU-HbA1c after reperfusion in diabetic patients with STEMI were associated with increased 12-month MACE, suggesting continuous serum glucose level control even after reperfusion is important for a better outcome. FU-HbA1c seems to be a useful marker for predicting clinical outcome.
aDepartment of Cardiology bDepartment of Biostatistics, Clinical Trial Center, Pusan National University Hospital, Busan cDepartment of Cardiology, Chonnam National University Hospital, Gwangju dDepartment of Cardiology, Kyungpook National University Hospital eDepartment of Cardiology, Keimyung University Hospital, Daegu fDepartment of Cardiology, Yeungnam University Hospital, Gyeongsan gDepartment of Cardiology, Chungnam National University Hospital hDepartment of Cardiology, Konyang University Hospital, Daejeon iDepartment of Cardiology, Yonsei University Severans Hospital jDepartment of Cardiology, Kyung Hee University Hospital kDepartment of Cardiology, Catholic University Hospital lDepartment of Cardiology, Korea University Hospital, Seoul mDepartment of Cardiology, Chungbuk National University Hospital, Cheongju nDepartment of Cardiology, Ulsan University Hospital, Ulsan, South Korea.
Jinhee
J
Ahn
Taek Jong
TJ
Hong
Jin Sup
JS
Park
Hye Won
HW
Lee
Jun-Hyok
JH
Oh
Jung Hyun
JH
Choi
Han Cheol
HC
Lee
Kwang Soo
KS
Cha
Eunyoung
E
Yun
Myung Ho
MH
Jeong
Shung Chull
SC
Chae
Young Jo
YJ
Kim
Seung Ho
SH
Hur
In Whan
IW
Seong
Yang Soo
YS
Jang
Myeong Chan
MC
Cho
Chong Jin
CJ
Kim
Ki Bae
KB
Seung
Seung Woon
SW
Rha
Jang Ho
JH
Bae
Seung Jung
SJ
Park
D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D048909:Diabetes Complications / Q000628:therapy*; D003920:Diabetes Mellitus / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human