Haemoglobin A1c, acute hyperglycaemia and short-term prognosis in patients without diabetes following acute ST-segment elevation myocardial infarction

摘要

Aims To assess the prognostic impact of HbA1c and blood glucose level in patients with acute ST-segment elevation myocardial infarction and without diabetes. The relationship between HbA1c and acute hyperglycaemia was also explored. Methods and results We evaluated 4793 ST-segment elevation myocardial infarction patients with baseline HbA1c and three glucose measurements in the first 24h. First, patients were stratified into quintiles by HbA1c and mean/admission glucose level. A total of 373 deaths (7.8%) occurred at 7days, and 486 deaths (10.1%) occurred at 30days. There were no significant differences in 7- and 30-day mortality, and major adverse cardiovascular event rates across HbA1c quintiles ( 34.4 mmol/mol (5.3%), 34.4 to 37.7 mmol/mol (5.6%), 37.7 to 41.0 mmol/mol (5.9%), 41.0 to 47.5 mmol/mol (6.5%), and ≥47.5 mmol/mol; P for trend 0.05). The risks of mortality and major adverse cardiovascular events were significantly increased in patients with higher glucose quintiles and lower quintile compared with the middle quintile after multivariable adjustment (P0.001). Patients were then reclassified into four groups according to mean/admission glucose and HbA1c levels. The group with elevated glucose and non-elevated HbA1c was associated with the highest mortality and major adverse cardiovascular event risk (P0.001). Conclusions Unlike acute hyperglycaemia, an elevated HbA1c level was not a risk factor for short-term outcomes in ST-segment elevation myocardial infarction patients without diabetes. Patients with acute hyperglycaemia and non-elevated HbA1c were associated with the worst prognosis. That suggests chronic glycaemic control/HbA1c level may help to recognize stress-induced hyperglycaemia and identify high-risk patients.