Prognostic Value of Admission Glycosylated Hemoglobin and Glucose in Nondiabetic Patients With ST-Segment–Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention

• Published in: Circulation (New York, N.Y.) Vol. 124; no. 6; pp. 704 - 711
• Main Authors: Timmer, Jorik R., Hoekstra, Miriam, Nijsten, Maarten W.N., van der Horst, Iwan C.C., Ottervanger, Jan Paul, Slingerland, Robbert J., Dambrink, Jan-Henk E., Bilo, Henk J.G., Zijlstra, Felix, van 't Hof, Arnoud W.J.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 09.08.2011
• Subjects: Adult; Angioplasty, Balloon, Coronary; Anticoagulants - therapeutic use; Biological and medical sciences; Biomarkers; Blood and lymphatic vessels; Blood Glucose - analysis; Cardiology. Vascular system; Combined Modality Therapy; Coronary heart disease; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - diagnosis; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Electrocardiography; Female; Follow-Up Studies; Glucose Metabolism Disorders - blood; Glucose Metabolism Disorders - complications; Glycated Hemoglobin A - analysis; Heart; Humans; Hyperglycemia - blood; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Myocardial Infarction - pathology; Myocardial Infarction - therapy; Netherlands - epidemiology; Patient Admission; Prognosis; Proportional Hazards Models; Human; Myocardial infarction; Prognosis; Cardiovascular disease; Glucose; hemoglobin A; Coronary heart disease; Myocardial disease; Percutaneous route; ST elevation; Treatment; glycosylated; Hemoglobin
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.110.985911

In nondiabetic patients with ST-segment-elevation myocardial infarction, acute hyperglycemia is associated with adverse outcome. Whether this association is due merely to hyperglycemia as an acute stress response or whether longer-term glycometabolic derangements are also involved is uncertain. It was our aim to determine the association between both acute and chronic hyperglycemia (hemoglobin A(₁c) [HbA(₁c)]) and outcome in nondiabetic patients with ST-segment-elevation myocardial infarction. This observational study included consecutive patients (n=4176) without known diabetes mellitus admitted with ST-segment-elevation myocardial infarction. All patients were treated with primary percutaneous intervention. Both glucose and HbA(1c) were measured on admission. Main outcome measure was total long-term mortality; secondary outcome measures were 1-year mortality and enzymatic infarct size. One-year mortality was 4.7%, and mortality after total follow-up (3.3 ± 1.5 years) was 10%. Both elevated HbA(1c) levels (P<0.001) and elevated admission glucose (P<0.001) were associated with 1-year and long-term mortality. After exclusion of early mortality (within 30 days), HbA(₁c) remained associated with long-term mortality (P<0.001), whereas glucose lost significance (P=0.09). Elevated glucose, but not elevated HbA(₁c), was associated with larger infarct size. After multivariate analysis, HbA(₁c) (hazard ratio, 1.2 per interquartile range; P<0.01), but not glucose, was independently associated with long-term mortality. In nondiabetic patients with ST-segment-elevation myocardial infarction, both elevated admission glucose and HbA(₁c) levels were associated with adverse outcome. Both of these parameters reflect different patient populations, and their association with outcome is probably due to different mechanisms. Measurement of both parameters enables identification of these high-risk groups for aggressive secondary risk prevention.