Prognostic value of HbA1c and plasma glucose on one-year mortality in non-diabetic patients after acute myocardial infarction

Abstract

The usefulness of the combined assessment of HbA1c and plasma glucose (PG) in acute myocardial infarction (AMI) in non-diabetic patients remains unclear. In a large observational study, we aimed to identify the prognostic values of these biomarkers regarding one-year all-cause mortality in non-diabetic patients after AMI. From the “obseRvatoire des Infarctus de Côte d’Or” (RICO) survey database, we included all consecutive non-diabetic patients with AMI ( n = 6617) from 2001 to 2016. The primary endpoint was all-cause one-year mortality. The secondary endpoints were: MACE, infarct size, LVEF < 40% and GRACE risk score. Cut off levels (high/low) were determined by ROC curve analysis for the prediction of one-year death (HbA 1c 5.9% and PG 7.3 mmol/L) to set up 4 groups: low HbA 1c /low glucose ( n = 3158), low HbA 1c /high glucose ( n = 1264), high HbA 1c /low glucose ( n = 1378) and high HbA 1c /high glucose ( n = 817). Elevation of PG was associated with elevated rate of LVEF < 40%, STEMI, anterior wall location, DFG < 60 mL/min/m 2 and higher troponin Ic pic (all P < 0.001); HbA 1c > 5.9% was associated with elevated rate of CRP > 3 mg/L ( P < 0.001); High HbA 1C and high PG together were associated with higher rate of MACE ( P < 0.001). By multivariate logistic regression analysis, elevated admission PG remained a strong predictor of one-year all-cause (OR (95%CI): 1.64 (1.31–2.05)) mortality and cardiovascular mortality (OR (95%CI): 1.75 (1.33–2.31)), beyond GRACE score (OR (95%CI): 1.03 (1.03–1.04)), as well as elevated HbA 1c (OR (95%CI): 1.43 (1.15–1.78) and OR (95%CI): 1.83 (1.39–2.41) respectively). Admission PG and HbA 1c had strong independent predictive value regarding one-year all-cause mortality in our nondiabetic patients with AMI. These biomarkers could be useful to identify the most-at-risk patients after AMI in order to reduce residual risk in this target population.