Is There A Role of Glycated Hemoglobin for Predicting Major Ad- verse Cardiac Event in ST-Elevation Myocardial Infarction?

Muhammad Abusari,Dadang Hendrawan,Yoga Waranugraha,Cholid Tri Tjahjono,Ratna Pancasari,Ayu Asri Devi Adityawati

doi:10.21776/ub.hsj.2020.001.03.4

Abstract

Background : Coronary Artery Disease (CAD) especially ST-Elevation Myocardial Infarction (STEMI) is the leading cause of mortality worldwide. Hyperglycemia and diabetes mellitus are both prevalent among patients with STEMI admitted to the hospital. Glycated hemoglobin (HbA1c) is a marker of glucose control. Objectives : We aimed to investigate the role of HbA1c as the predictor of major adverse cardiovascular events in STEMI patients. Methods : This was a retrospective cohort study. STEMI patients visiting Saiful Anwar General Hospital were registered. Patients were divided into three groups based on the HbA1c level <6.5%; 6.5-8.4% and ≥8.5%; respectively. The primary endpoint was in-hospital Major Adverse Cardiovascular Events (MACE), including cardiac death, recurrent myocardial infarction (MI), recurrent revascularization, acute pulmonary edema, cardiogenic shock, malignant arrhythmia, and stroke. Results: A total of 118 STEMI patients were included in this study, with distribution of 61 patients with HbA1c <6.5%, 25 patients with HbA1c 6.5-8.4%, and 31 patients with HbA1c ≥8.5%; respectively. The HbA1C level was associated with the history of diabetes mellitus (3.2% vs 36% vs 71%; p =0.000) and random blood glucose level at hospital admission (140.71 ± 39.67 mg/dL vs 172.96 ± 53.43 mg/dL vs 366.61 ± 169.67 mg/dL; p = 0.000). The MACE among three groups was not significantly different (17.7% vs 20% vs 35.5%; p=0,149). Conclusion: Our study reveals that the HbA1c level at hospital admission is associated with the history of diabetes mellitus and random blood glucose at hospital admission. However, HbA1c could not predict MACE in STEMI patients

Highlights

In the past decades, rapid and sustained increase of prevalence of cardiovascular disease (CVD),[1] leads to a tremendous disease burden around the world
Acute coronary syndrome (ACS), which consist of Unstable Angina (UA), ST-Elevation Myocardial Infarction (STEMI), and non-STEMI, is responsible for almost half of the CVD-associated morbidity.[2]
The mortality in STEMI patients can be affected by several factors, such as the history of previous myocardial infarction (MI), Killip class, advanced age, emergency medical system (EMS)-based STEMI networks presence, time delay to treatment, treatment strategy, left ventricular ejection fraction (LVEF), number of diseased coronary arteries, diabetes mellitus, and renal failure.[3,4]

Summary

Introduction

Rapid and sustained increase of prevalence of cardiovascular disease (CVD),[1] leads to a tremendous disease burden around the world. Acute coronary syndrome (ACS), which consist of Unstable Angina (UA), STEMI, and non-STEMI, is responsible for almost half of the CVD-associated morbidity.[2] STEMI is associated with acute total occlusion of the coronary arteries. It is the most high-risk emergency condition and still be the highest cause of mortality and morbidity. Conclusion: Our study reveals that the HbA1c level at hospital admission is associated with the history of diabetes mellitus and random blood glucose at hospital admission.

Objectives

Methods

Findings

Conclusion