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Park S, Choi WG, Bae DH, Kim M, Lee JH, Kim S, Bae JW, Kim DW, Cho MC, Kim CJ, Chae SC, Jeong MH, Hwang KK. Effect of hemoglobin A1c change on 24-month clinical outcomes in patients with diabetes after acute myocardial infarction. Coron Artery Dis 2024:00019501-990000000-00220. [PMID: 38682470 DOI: 10.1097/mca.0000000000001369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND The average glycated hemoglobin (HbA1c) may not accurately reflect glycemic control status during the mid-term after acute myocardial infarction (AMI). We aimed to evaluate changes in HbA1c and their effect on mid-term clinical outcomes in patients with diabetes and AMI. METHODS We enrolled patients with diabetes (n = 967) who underwent HbA1c measurement in the Korean nationwide registry. These patients were categorized into three groups based on changes in HbA1c from index admission to the 1-year follow-up visit: a decrease in HbA1c > 1%, changes in HbA1c within 1%, and an increase in HbA1c > 1%. Clinical outcomes at 24 months were examined. RESULTS The baseline HbA1c levels were 8.55 ± 0.85, 7.00 ± 0.98 and 7.07 ± 1.05 (P = 0.001) and HbA1c levels after 1 year were 6.62 ± 0.73, 7.05 ± 0.98 and 9.26 ± 1.59 (P = 0.001) for patients with 3 groups, respectively. Patients with a 1% decrease in HbA1c had significantly lower incidence of major adverse cardiovascular events (MACE), cardiac death, and rehospitalization after 24 months than those with a 1% increase in HbA1c. However, in the Cox regression analysis, a >1% decrease in HbA1c change was not an independent factor for MACE, cardiac death, and rehospitalization. CONCLUSIONS Our analysis indicates that an HbA1c decrease of >1% within the first 12 months was not an independent prognostic factor until the 24-month mark. Therefore, standard diabetic control is recommended for patients with diabetes and AMI for up to 2 years.
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Affiliation(s)
- Sangshin Park
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital
| | - Woong Gil Choi
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju
| | - Dae-Hwan Bae
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital
| | - Min Kim
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital
| | - Ju-Hee Lee
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital
| | - Sangmin Kim
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju
| | - Jang-Whan Bae
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju
| | - Dong-Woon Kim
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju
| | - Myeong-Chan Cho
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju
| | - Chong-Jin Kim
- Department of Internal Medicine, Kyunghee University College of Medicine, Seoul
| | - Shung-Chull Chae
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu
| | - Myung-Ho Jeong
- Department of Internal Medicine and Heart Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kyung-Kuk Hwang
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju
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Rajpurohit A, Sejoo B, Bhati R, Keswani P, Sharma S, Sharma D, Meena DS, Midha NK. Association of Stress hyperglycemia and adverse cardiac events in acute myocardial infarction - A cohort study. Cardiovasc Hematol Disord Drug Targets 2021; 21:260-265. [PMID: 34939555 DOI: 10.2174/1871529x22666211221152546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/04/2021] [Accepted: 11/23/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Stress hyperglycemia is a common phenomenon in patients presenting with acute myocardial infarction (MI). We aim to evaluate the association of stress hyperglycemia at the time of hospital presentation and adverse cardiac events in myocardial infarction during the course of hospital stay. METHODS Subjects with age ≥18 years with acute MI were recruited on hospital admission and categorized based on admission blood glucose (<180 and ≥180 mg/dl, 50 patients in each group). Both groups were compared for clinical outcomes, adverse cardiac events and mortality. We also compared the adverse cardiac outcomes based on HbA1c levels (<6% and ≥6%). RESULTS Patients with high blood glucose on admission (stress hyperglycemia) had significant increased incidences of severe heart failure (Killip class 3 and 4), arrythmias, cardiogenic shock and mortality (p value = 0.001, 0.004, 0.044, and 0.008 respectively). There was no significant association between adverse cardiac events and HbA1c levels (heart failure 18.8% vs. 25%, p value = 0.609 and mortality 16.7% vs. 17.3%, p value = 0.856). CONCLUSIONS Stress hyperglycemia is significantly associated with adverse clinical outcomes in patients with MI irrespective of previous diabetic history or glycemic control. Clinicians should be vigilant for admission blood glucose while treating MI patients.
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Affiliation(s)
- Annu Rajpurohit
- Department of Oncology, Tata Memorial Hospital Mumbai. India
| | - Bharat Sejoo
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur. India
| | | | | | | | - Deepak Sharma
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur. India
| | - Durga Shankar Meena
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur. India
| | - Naresh Kumar Midha
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur. India
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Yang T, Fu P, Chen J, Fu X, Xu C, Liu X, Niu T. Increased risk of adverse cardiovascular events by strict glycemic control after percutaneous coronary intervention (HbA1c < 6.5% at 2 years) in type 2 diabetes mellitus combined with acute coronary syndrome: a 5-years follow-up study. Curr Med Res Opin 2021; 37:1517-1528. [PMID: 34166166 DOI: 10.1080/03007995.2021.1947219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study assessed the association between HbA1c level measured 2 years after percutaneous coronary intervention (PCI) and long-term clinical outcomes in type 2 diabetes mellitus combined with acute coronary syndrome (ACS) who underwent PCI. METHODS This prospective observational study analyzed 2877 ACS patients with type 2 diabetes mellitus whose baseline HbA1c ≥ 7.0% and underwent PCI. All patients were divided into 6 groups according to the HbA1c level at 2 years after PCI. The clinical outcome was major adverse cardiovascular events (MACEs), defined as all-cause death, all myocardial infarction, any revascularization, congestive heart failure, ischemic stroke. The median follow-up duration was 4.1 years. RESULTS All 2877 patients were divided into 6 groups: 2-year after PCI HbA1c < 6.0% (n = 219), 6.0-6.5% (n = 348), 6.5-7.0% (n = 882), 7.0-7.5% (n = 567), 7.5-8.0% (n = 441), ≥8.0% (n = 420). The 5-year incidence rate of MACEs in HbA1c <6.0% and 6.0-6.5% groups were similar to 7.5-8.0% and ≥8.0% groups, which were significantly higher than in 6.5-7.0% and 7.0-7.5% groups (p = .044). The cumulative incidence rate of MACEs significantly differed among the groups (p = .046). Multivariate Cox regression analysis revealed a U-shaped relationship between 2-year HbA1c level after PCI and risk of MACEs. 2-year HbA1c <6.5% after PCI was an independent risk factor for MACEs in type 2 diabetes mellitus combined with ACS who underwent PCI (p < .001). CONCLUSIONS The findings indicated an increased risk of MACEs by strict glycemic control after PCI (2-year HbA1c < 6.5% after PCI) in type 2 diabetes mellitus combined with ACS who underwent PCI.
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Affiliation(s)
- Tiangui Yang
- Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Peng Fu
- Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jie Chen
- Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xi Fu
- Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Changlu Xu
- Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaoxia Liu
- Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Tiesheng Niu
- Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Changes over Time in Hemoglobin A1C (HbA 1C) Levels Predict Long-Term Survival Following Acute Myocardial Infarction among Patients with Diabetes Mellitus. J Clin Med 2021; 10:jcm10153232. [PMID: 34362016 PMCID: PMC8348956 DOI: 10.3390/jcm10153232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022] Open
Abstract
Frequent fluctuations of hemoglobin A1c (HbA1C) values predict patient outcomes. However, data regarding prognoses depending on the long-term changes in HbA1C among patients after acute myocardial infarction (AMI) are scarce. We evaluated the prognostic significance of HbA1C levels and changes among diabetic patients (n = 4066) after non-fatal AMI. All the results of HbA1C tests up to the 10-year follow-up were obtained. The changes (∆) of HbA1C were calculated in each patient. The time intervals of ∆HbA1C values were classified as rapid (<one year) and slow (≥one year) changes. The outcome was all-cause mortality. The highest mortality rates of 53.8% and 35.5% were found in the HbA1C < 5.5–7% and ∆HbA1C = −2.5–(−2%) categories. A U-shaped association was observed between HbA1C and mortality: adjOR = 1.887 and adjOR = 1.302 for HbA1C < 5.5% and ≥8.0%, respectively, as compared with 5.5–6.5% (p < 0.001). Additionally, ∆HbA1C was associated with the outcome (U-shaped): adjOR = 2.376 and adjOR = 1.340 for the groups of <−2.5% and ≥2.5% ∆HbA1C, respectively, as compared to minimal ∆HbA1C (±0.5%) (p < 0.001). A rapid increase in HbA1C (but not decrease) was associated with a greater risk of mortality. HbA1C values and their changes are significant prognostic markers for long-term mortality among AMI-DM patients. ∆HbA1C and its timing, in addition to absolute HbA1C values, should be monitored.
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Aleksova A, Ferro F, Gagno G, Padoan L, Saro R, Santon D, Stenner E, Barbati G, Cappelletto C, Rossi M, Beltrami AP, Sinagra G. Diabetes Mellitus and Vitamin D Deficiency:Comparable Effect on Survival and a DeadlyAssociation after a Myocardial Infarction. J Clin Med 2020; 9:jcm9072127. [PMID: 32640692 PMCID: PMC7408858 DOI: 10.3390/jcm9072127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 02/06/2023] Open
Abstract
Survivors after a myocardial infarction (MI), especially those with diabetes mellitus (DM), remain at high risk of further events. Identifying and treating factors that may influence survival may open new therapeutic strategies. We assessed the impact on prognosis of DM and hypovitaminosis D (hypovitD), alone or combined. In this prospective, observational study, 1081 patients were enrolled surviving an MI and divided into four groups according to their diabetic and VitD status. The primary end-point was composite of all-cause mortality, angina/MI and heart failure (HF). Secondary outcomes were mortality, HF and angina/MI. During a follow-up of 26.1 months (IQR 6.6–64.5), 391 subjects experienced the primary end-point. Patients with DM or hypovitD had similar rate of the composite end-point. Patients with only hypovitD or DM did not differ regarding components of composite end-point (angina p = 0.97, HF p = 0.29, mortality p = 0.62). DM and VitD deficiency had similarly adjusted risks for primary end-point (HR 1.3, 95%CI 1.05–1.61; HR 1.3, 95% CI 1.04–1.64). The adjusted HR for primary composite end-point for patients with hypovitD and DM was 1.69 (95%CI 1.25–2.29, p = 0.001) in comparison to patients with neither hypoD nor DM. In conclusion, DM and hypovitD, individually and synergistically, are associated with a worse outcome after MI.
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Affiliation(s)
- Aneta Aleksova
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (F.F.); (G.G.); (R.S.); (C.C.); (M.R.); (G.S.)
- Correspondence: ; Tel.: +39-340-550-7762; Fax: +39-040-399-4878
| | - Federico Ferro
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (F.F.); (G.G.); (R.S.); (C.C.); (M.R.); (G.S.)
| | - Giulia Gagno
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (F.F.); (G.G.); (R.S.); (C.C.); (M.R.); (G.S.)
| | - Laura Padoan
- Azienda Ospedaliera di Perugia and University of Perugia, Cardiology and Cardiovascular Physiopathology, 06156 Perugia, Italy;
| | - Riccardo Saro
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (F.F.); (G.G.); (R.S.); (C.C.); (M.R.); (G.S.)
| | - Daniela Santon
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34100 Trieste, Italy; (D.S.); (E.S.)
| | - Elisabetta Stenner
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34100 Trieste, Italy; (D.S.); (E.S.)
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy;
| | - Chiara Cappelletto
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (F.F.); (G.G.); (R.S.); (C.C.); (M.R.); (G.S.)
| | - Maddalena Rossi
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (F.F.); (G.G.); (R.S.); (C.C.); (M.R.); (G.S.)
| | | | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Department of Medical Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (F.F.); (G.G.); (R.S.); (C.C.); (M.R.); (G.S.)
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