DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20160291

Prognostic implications of glycated hemoglobin in nondiabetic patients with acute coronary syndrome

Namita Mohanty, Debakanta Mishra, Suvendu Sekhar Acharya, Sijoy Kurian, Suprabhat Giri

Abstract


Background: In nondiabetic patients with acute coronary syndrome, 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 chronic hyperglycemia (hemoglobin A1c (HbA1c) and outcome in nondiabetic patients with acute coronary syndrome.

Methods: This observational study included consecutive patients (n=47) without known diabetes mellitus admitted with acute coronary syndrome (STEMI, NSTEMI, UA). HbA1c was measured on admission. The main outcome was MACE (major adverse cardiac events including death, cardiogenic shock, arrhythmia, heart failure). The patients were divided into 2 groups according to their HbA1c level (group 1 HbA1c<5.7%, group 2 HbA1c>5.7%).

Results: There was no significant difference between baseline characteristics of both groups but complications were seen in higher number cases with HbA1c >5.7%. No significant difference in mortality was found. On multivariate logistic regression analysis HbA1c >5.7% was found to be an independent predictor of MACE.

Conclusions: There was no significant difference between baseline characteristics of both groups but complications were seen in higher number cases with HbA1c>5.7%. No significant difference in mortality was found. On multivariate logistic regression analysis HbA1c>5.7% was found to be an independent predictor of MACE.

 


Keywords


HbA1c, Acute coronary syndrome, Nondiabetic

Full Text:

PDF

References


K Park Coronary heart disease, Text book of preventive and social medicine,22 nd edition, M/S Banarasidas Bhanot, Jabalpur. 2005:339.

Garcia MJ, McNamara PM, Gordon T, Kannel WB. Morbidity and mortality in diabetes in the Framingham population. Diabetes. 1974;23:105-16.

Wiviott, Stephen D. Greater clinical benefit of more intensive oral antiplatelet therapy with prasugrel in patients with diabetes mellitus in the trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel–Thrombolysis in Myocardial Infarction 38. Circulation. 2008;118,16:1626-36.

Orasanu, Gabriela, Plutzky J. The pathologic continuum of diabetic vascular disease. Journal of the American College of Cardiology. 2009:S35-S42.

Prakash D. Hyperglycemia and Acute Coronary Syndrome A Scientific Statement From the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2008;117.12:1610-19.

Selvin, Elizabeth. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. New England Journal of Medicine. 2010; 362.9:800-11.

Goyal A, Mehta SR, Diaz R, Gerstein HC, Afzal R, Xavier D. Differential clinical outcomes associated with hypoglycemia and hyperglycemia in acute myocardial infarction. Circulation. 2009;120:2429-37.

Timmer, Jorik R. Prognostic value of admission glucose in non-diabetic patients with myocardial infarction. American heart journal. 2004;148,3:399-404.

Stolar M. Glycemic control and complications in type 2 diabetes mellitus.Am J Med. 2010;123:S3–S11.

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes care. 2010;33,(1):S62-S69.

World Health Organisation Study Group. Diabetes mellitus. WHO Tech Rep Ser. 1985;727:1-104.

Coutinho M, Wang Y, Gerstein HC, Yusuf S. The relationship between glucose and incident cardiovascular events. Diabetes Care. 1999;22(2):233-40.

Kay-Tee Khaw, Wareham N, Luben R, Bingham S, Oakes S, Wilch A. Glycated haemoglobin diabetes and mortality in men in North Cohort of European Prospective Investigation of cancer and nutrition (EPIL-NORFOLK). BMJ. 2001;322:15-32.

Ko GT, Chan JC, Woo J, Lau E, Yeung VT, Chow CC. Glycated hemoglobin and cardiovascular risk factors in Chinese subjects with normal glucose tolerance. Diabetes Medicine. 1998;15:573-8.

Timmer JR, Hoekstra M, Nijsten MW, van der Horst IC, Ottevanger JP, Slingerland RJ. Prognostic value of admission glycosylated hemoglobin and glucose in nondiabetic patients with ST-segment-elevation myocardial infarction treated with percutaneous coronary intervention. Circulation. 2011;124:704-11.

Grundy, Scott M. Pre-diabetes, metabolic syndrome, and cardiovascular risk. Journal of the American College of Cardiology. 2012;59,7:635-43.

Ryden L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, de BoerMJ. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: the Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J. 2007;28:88-136.