DOI: http://dx.doi.org/10.18203/2349-3933.ijam20210077

Impact of glycosylated haemoglobin (HbA1c) levels on outcomes in patients with myocardial infarction

Prabhat Pandey, Neeraj Dokania, Pooja Pandey, Ajay Singh Raghuwanshi

Abstract


Background: People with diabetes have an increased prevalence of atherosclerosis and coronary heart disease (CHD) and experience higher morbidity and mortality after acute coronary syndrome and myocardial infarction than people without diabetes. Diabetes also appears to be a major cause of the higher rate of both short and long-term mortality observed in women hospitalized with acute MI compared to men. Objective of the study was to observe the impact of glycosylated hemoglobin (HbA1c) levels on outcomes in MI.

Methods: The prospective observational study was conducted on 200 patients from the age group more than 36 years and lesser than 95 years presented with acute myocardial infarction (STEMI or NSTEMI). Patients were divided into group A (Diabetics) and group B (non-diabetics). Investigations performed were FBS, RBS, HbA1c, CBC, LFT, RFT, lipid profile, ECG and echocardiography. Patients were followed up till discharge/death and all complications like arrhythmias, cardiac failure, cardiogenic shock and re infarction were noted.

Results: Majority of the 34.5% patients belongs to the age group of 56-65 years. No significant difference found between the subject population of the diabetic and non-diabetic group. The percentage of mortality in male patients was reported higher in the group having HbAlc level ≥7 (21.15%) in comparison to a group having HbAlc level <7 (6.15%) whereas in females the percentage of mortality was 11.63% in the group having HbAlc ≥7 , higher than the group having HbAlc level <7, 2.5%. Percentage mortality was higher in the patients having HbAlc >7, in both groups’ patients aged below 60 years 14.81% and 17.65% in the group of patients aged above 60 years.

Conclusions: Higher HbAlc level significantly affects the outcome of MI patients. The percentage mortality due to MI was higher in male with aged above 60 years and having HbAlc level >7.


Keywords


Diabetes, Coronary heart disease, HbA1c level, ST elevation myocardial infarction

Full Text:

PDF

References


Haffner SM, Lehto S, Ronnema T. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229-34.

Gu K, Cowie CC, Harris MI. Diabetes and decline in heart disease mortality in US adults. JAMA. 1999;281:1291-7.

Malmberg K, Yusuf S, Gerstein HC. Impact of Diabetes on Long-Term Prognosis in Patients with Unstable Angina and Non-Q-Wave Myocardial Infarction. Results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) Registry. Circulation. 2000;102:1014-9.

Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA. ACCF/SCAI/STS/AATS/AHA/ASNC/ HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol. 2012;59:857-81.

Corrà U, Piepoli MF, Carré F. for the European Association of Cardiovascular Prevention and Rehabilitation Committee for Science Guidelines; EACPR: secondary prevention through cardiac rehabilitation: physical activity and exercise training: key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur Heart J. 2010;31:1967-74.

Steg PG, James SK, Atar D. The Task Force on the Management of ST Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology (ESC), ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33:2569-619.

Ishihara M, Kojima S, Sakamoto T, Asada Y, Tei C, Kimura K, et al. Acute hyperglycemia is associated with adverse outcomeafter acute myocardial infarction in the coronary intervention era. Am Heart J. 2005;150:814-20.

Kosiborod M, Rathore SS, Inzucchi SE, Masoudi FA, Wang Y, Havranek EP, et al. Admission glucose and mortality in elderly patients hospitalizedwith acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation. 2005;111:3078-86.

Sinnaeve PR, Steg PG, Fox KA, Van de Werf F, Montalescot G, Granger CB, et al. Association of elevated fasting glucose with increased short-term and 6-monthmortality in ST-segment elevation and non-ST-segment elevation acute coronary syndromes: the global registry of acute coronary events. Arch Intern Med. 2009;169:402-9.

Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet. 2000;355:773-8.

Hadjadj S, Coisne D, Mauco G, Ragot S, Duengler F, Sosner P, et al. Prognostic value of admission plasma glucose and HbA in acute myocardial infarction. Diabet Med. 2004;21:305-10.

Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321:405-12.

Bhatti MF, Afzal MAB, Latif A, Hassan Z, Shahzad S. Myocardial infarction; risk factor associated with st-segment elevation myocardial infarction in cardiac emergency of allama iqbal memorial teaching hospital: Prevalence and Comparison. Professional Med J. 2019;26(1):83-9.

O’Sullivan CJ, Hynes N, Mahendran B. Haemoglobin A1c (HbA1C) in Non-diabetic and Diabetic Vascular Patients. Is HbA1C an Independent Risk Factor and Predictor of Adverse Outcome. Eur J Vasc Endovasc Surg. 2006;32:188-97.

Cakmak M, Cakmak N, Cetemen S. The value of admission glycosylated hemoglobin level in patients with acute myocardial infarction. Can J Cardiol. 2008;24(5):375-8.

Muntner P, Desalvo KB, Wildman RP. Relationship Between HbA1c Level and Peripheral Arterial Disease. Diabetes Care. 2005;28:8.