The Value of Admission HbA_1c Level in Diabetic Patients With Acute Coronary Syndrome

摘要

Background:Elevated admission glucose level is a strong predictor of short-term adverse outcome in patients with acute coronary syndrome (ACS). However, the prognostic value of diabetic control (ie, hemoglobin A_1c levels) in patients with ACS is still undefined.Hypothesis:Hemoglobin A_1c level may predict short-term outcome in patients with ACS.Methods:We conducted a retrospective study with prospective follow-up in 317 diabetic patients with ACS. Patients were stratified into 2 groups based on HbA_1c level, checked within 8 weeks of the index admission (optimal control group, HbA_1c ≤7%; suboptimal control group, HbA_1c 7%). All patients were followed up prospectively for major adverse cardiovascular events (MACE) and mortality for 6 months. Short-term clinical outcomes were also compared between the 2 study groups.Results:In our cohort, 27.4%, 46.4%, and 26.2% patients had unstable angina, non–ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction, respectively. In-hospital mortality was similar in both HbA_1c groups (3.37% vs 2.88%, P = 0.803). Six-month MACE was also similar (26.40% vs 26.47%, P = 0.919). All-cause mortality, cardiovascular mortality, symptom-driven revascularization, rehospitalization for angina, and hospitalization for heart failure were also similar in both groups. The hazard ratios for 6-month MACE and individual endpoints were also similar in both groups.Conclusions:This study suggests that HbA_1c levels before admission are not associated with short-term cardiovascular outcome in diabetic patients subsequently admitted with ACS. ? 2011 Wiley Periodicals, Inc.The authors have no funding, financial relationships, or conflicts of interest to disclose.