The value of admission HbA 1c level in diabetic patients with acute coronary syndrome

Abstract

Background: Elevated admission glucose level is a strong predictor of short-term adverse outcome in patients with acute coronary syndrome (ACS). However, the prognostic value of diabetic control (ie, hemoglobin A 1c levels) in patients with ACS is still undefined. Hypothesis: Hemoglobin A 1c level may predict short-term outcome in patients with ACS. Methods: We conducted a retrospective study with prospective follow-up in 317 diabetic patients with ACS. Patients were stratified into 2 groups based on HbA 1c level, checked within 8 weeks of the index admission (optimal control group, HbA 1c ≤ 7% suboptimal control group, HbA >7%). All patients were followed up prospectively for major adverse cardiovascular events (MACE) and mortality for 6 months. Short-term clinical outcomes were also compared between the 2 study groups. Results: In our cohort, 27.4%, 46.4%, and 26.2% patients had unstable angina, non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction, respectively. In-hospital mortality was similar in both HbA groups (3.37% vs 2.88%, P = 0.803). Six-month MACE was also similar (26.40% vs 26.47%, P = 0.919). All-cause mortality, cardiovascular mortality, symptom-driven revascularization, rehospitalization for angina, and hospitalization for heart failure were also similar in both groups. The hazard ratios for 6-month MACE and individual endpoints were also similar in both groups. Conclusions: This study suggests that HbA 1c levels before admission are not associated with short-term cardiovascular outcome in diabetic patients subsequently admitted with ACS. © 2011 Wiley Periodicals, Inc.