Abstract 10649: Changes Over Time in Hemoglobin A1c (hba 1c ) Levels Predict Long-Term Survival Following Acute Myocardial Infarction

Abstract

Introduction: Frequent fluctuations in hemoglobin A1c (HbA 1C ) values are independent predictors of diabetic complications and patient outcomes. Objective: To evaluate the prognostic significance of HbA 1C levels and its changes among diabetic patients after non-fatal AMI. Methods: Patients with diabetes mellitus (DM) who were admitted to a tertiary medical center with AMI throughout 2002-2017 and survived >1year thereafter were evaluated. All the results of HbA 1C values during the follow-up period (up to 10-years after discharge) were obtained and analyzed. The changes (Δ) of HbA 1C were calculated for all pairs of tests in each patient. The time interval of ΔHbA 1C values was classified as rapid (<1 year) and slow (≥1 year) change. The outcome was all-cause mortality. Results: A total of 4,066 patients were analyzed, mean age 66.4±11.9 years, 36% females. A U-shaped association was observed between HbA1C and mortality: adjOR=1.887 and adjOR=1.302 for HbA 1C <5.5% and ≥8.0% respectively, as compared with 5.5-6.5% (p<0.001). A U-shaped independent association between ΔHbA 1C and long-term survival was found: adjOR=2.376 and adjOR=1.340 for the groups of <-2.5% and ≥2.5% HbA 1C changes respectively (p<0.001 for each), as compared to the group of minimal ΔHbA 1C (±0.5%). Rapid increase in HbA 1C (but not decrease) following AMI was associated with greater risk for mortality. Conclusions: HbA 1C values, its changes and their rate are significant independent prognostic markers for long-term all-cause mortality with a U-shaped association following non-fatal AMI among DM patients. Thus, ΔHbA 1C and its timing, in addition to absolute HbA 1C values should be monitored among these patients.