title: Glycosylated hemoglobin is associated with decreased endothelial function, high inflammatory response, and adverse clinical outcome in non-diabetic STEMI patients.
abstract: OBJECTIVE
  Chronic dysglycemia was recently identified as a predictor for adverse outcomes in patients with ST-elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention. Data for non-diabetic patients who underwent thrombolysis is scarce. In this context, we aimed to study the effect of HbA1c on cardiovascular outcome after STEMI.
  
  
  METHODS
  A prospective cohort of 326 non-diabetic STEMI individuals was used for the analyses. We measured plasma glucose, hemoglobin A1c [HbA1c], lipid profile, C-reactive protein (CRP), and nitrate/nitrite (NOx) upon admission and five days after STEMI (D5). Flow-mediated dilation (FMD) was performed 30 days after STEMI. During clinical follow-up, we assessed patients for incident diabetes (progression to HbA1c ≥ 6.5%) and major adverse cardiac events (MACE), defined as a composite of fatal and non-fatal MI, sudden cardiac death, and angina requiring hospitalization.
  
  
  RESULTS
  Using ROC-curve analysis, a 5.8% HbA1c best predicted MACE with a sensitivity of 75% and specificity of 53% (AUC 0.673, p = 0.001). Patients were categorized as high HbA1c if ≥ 5.8% and low HbA1c if <5.8%. Compared with patients with low HbA1c, those with high HbA1c presented with 20% higher CRP-D5 (p = 0.009) and 19% higher ΔCRP (p = 0.01), a 32% decrease in ΔNOx (p < 0.001), and 33% lower FMD (p < 0.001). After a median follow-up of 1.9 (1.1-2.8) years, patients with high HbA1c had more incident diabetes (HR 2.3 95% CI 1.01-5.2; p = 0.048) and MACE (HR 3.32 95% CI 1.09-10.03; p = 0.03).
  
  
  CONCLUSIONS
  Non-diabetic STEMI patients with high HbA1c present with decreased endothelial function and increased inflammatory response and long-term risk of MACE.
authors.affiliation: State University of Campinas Medicine School (UNICAMP), Campinas, SP, Brazil.
authors.forename: Filipe A
authors.initials: FA
authors.lastname: Moura
authors.affiliation: State University of Campinas Medicine School (UNICAMP), Campinas, SP, Brazil.
authors.forename: Valeria N
authors.initials: VN
authors.lastname: Figueiredo
authors.affiliation: University of Brasilia Medical School (UnB), Brasilia, Brazil.
authors.forename: Bruna S B S
authors.initials: BS
authors.lastname: Teles
authors.affiliation: University of Brasilia Medical School (UnB), Brasilia, Brazil.
authors.forename: Meyrianne A
authors.initials: MA
authors.lastname: Barbosa
authors.affiliation: University of Brasilia Medical School (UnB), Brasilia, Brazil.
authors.forename: Lara R
authors.initials: LR
authors.lastname: Pereira
authors.affiliation: University of Brasilia Medical School (UnB), Brasilia, Brazil.
authors.forename: Ana P R
authors.initials: AP
authors.lastname: Costa
authors.affiliation: State University of Campinas Medicine School (UNICAMP), Campinas, SP, Brazil.
authors.forename: Luiz Sergio F
authors.initials: LS
authors.lastname: Carvalho
authors.affiliation: State University of Campinas Medicine School (UNICAMP), Campinas, SP, Brazil.
authors.forename: Riobaldo M R
authors.initials: RM
authors.lastname: Cintra
authors.affiliation: Hospital de Base do Distrito Federal, Brasilia, DF, Brazil.
authors.forename: Osório L R
authors.initials: OL
authors.lastname: Almeida
authors.affiliation: Hospital de Base do Distrito Federal, Brasilia, DF, Brazil.
authors.forename: Jose C
authors.initials: JC
authors.lastname: Quinaglia E Silva
authors.affiliation: State University of Campinas Medicine School (UNICAMP), Campinas, SP, Brazil.
authors.forename: Wilson
authors.initials: W
authors.lastname: Nadruz Junior
authors.affiliation: State University of Campinas Medicine School (UNICAMP), Campinas, SP, Brazil. Electronic address: andreisposito@gmail.com.
authors.forename: Andrei C
authors.initials: AC
authors.lastname: Sposito
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001916:Brachial Artery / Q000473:pathology; D002097:C-Reactive Protein / Q000032:analysis; D017023:Coronary Angiography; D003920:Diabetes Mellitus; D004032:Diet; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007249:Inflammation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications; D009569:Nitric Oxide / Q000737:chemistry; D010343:Patient Admission; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; D009569:Nitric Oxide
keywords: Follow-up study; Glycosylated hemoglobin; Mortality; Myocardial infarction; Nitric oxide