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

BACKGROUND

The usefulness of the combined assessment of HbA1c and plasma glucose (PG) in acute myocardial infarction (AMI) in non-diabetic patients remains unclear.

PURPOSE

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.

METHODS

From the "obseRvatoire des Infarctus de Côte d'Or" (RICO) survey database, we included all consecutive non-diabetic patients with AMI (n=6617) from May 2001 to December 2016. Exclusion criteria were: admission known or unknown diabetes, in-hospital death. 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 (HbA1c 5.9% and PG 131mg/dL) to set up 4 groups: low HbA1c/low glucose (n=3158), low HbA1c/high glucose (n=1264), high HbA1c/low glucose (n=1378) and high HbA1c/high glucose (n=817).

RESULTS

Elevation of PG was associated with elevated rate of LVEF<40%, STEMI, anterior wall location, DFG<60mL/min/m² and higher troponin Ic pic (all P<0.001); HbA1c>5.9% was associated with elevated rate of CRP>3mg/L (P<0.001); high HbA1c 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 HbA1c [OR (95%CI): 1.43 (1.15-1.78) and OR (95%CI): 1.83 (1.39-2.41) respectively].

CONCLUSIONS

Admission PG and HbA1c had strong independent predictive value regarding one-year all-cause mortality in our non-diabetic 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.

P4570Prognostic interest of HbA1c and plasma glucose assessment on one-year mortality in non-diabetic patients after acute myocardial infarction

Background

The usefulness of the combined assessment of HbA1c and plasma glucose (PG) in acute myocardial infarction (AMI) in nondiabetic patients remains unclear.

Purpose

In a large observational study, we aimed to identify the prognostic values of these biomarkers regarding one-year all-cause mortality in nondiabetic patients after AMI.

Methods

From the “obseRvatoire des Infarctus de Côte d'Or” (RICO) survey database, we included all consecutive nondiabetic patients with AMI (n=6617) from May 2001 to December 2016. Exclusion criteria were: admission known or unknown diabetes, in-hospital death. 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 (HbA1c 5.9% and PG 7.3mmol/L) to set up 4 groups: low HbA1c/low glucose (n=3158), low HbA1c/high glucose (n=1264), high HbA1c/low glucose (n=1378) and high HbA1c/high glucose (n=817).

Results

Elevation of PG was associated with elevated rate of LVEF<40%, STEMI, anterior wall location, DFG<60mL/min/m2 and higher troponin Ic pic (all p<0.001); HbA1c>5.9% was associated with elevated rate of CRP>3mg/L (p<0.001); High HbA1C 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 HbA1c (OR (95% CI): 1.43 (1.15–1.78) and OR (95% CI): 1.83 (1.39–2.41) respectively).

Conclusions

Admission PG and HbA1c 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.

Acknowledgement/Funding

University Hospital Center Dijon Bourgogne, France