Hemoglobin Glycation Index and Prognosis in Patients With Acute Myocardial Infarction Without Reduced Left Ventricular Ejection Fraction: A Multicenter Retrospective Cohort Study

IF 5.9 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Pub Date : 2026-07-20 DOI:10.1111/1753-0407.70257

Shangjian Luo, Huan Liu, Xuesong Wen

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Abstract

Background

The prognostic value of the hemoglobin glycation index (HGI) in patients with acute myocardial infarction (AMI) without reduced left ventricular ejection fraction (LVEF) remains unclear.

Methods

This multicenter retrospective cohort study included 1706 patients with AMI without reduced LVEF. HGI was calculated as measured HbA1c minus predicted HbA1c. Restricted cubic spline (RCS) analysis was used to evaluate nonlinear associations between HGI and outcomes and identify the cutoff value. Piecewise Cox regression and subgroup analyses were also performed. The primary endpoint was major adverse cardiovascular events (MACEs), defined as a composite of rehospitalization for heart failure (HF), recurrent myocardial infarction (MI), and cardiovascular death.

Results

The median follow-up was 3.86 (2.30–4.98) years. RCS analysis showed a non-linear association between HGI and adverse outcomes, with a cutoff at −0.174. In patients with HGI ≤ −0.174, higher HGI was associated with lower risks of rehospitalization for HF (HR = 0.600, 95% CI: 0.464–0.776), recurrent MI (HR = 0.599, 95% CI: 0.365–0.983), cardiovascular death (HR = 0.627, 95% CI: 0.458–0.859), all-cause death (HR = 0.552, 95% CI: 0.428–0.713), and MACEs (HR = 0.603, 95% CI: 0.483–0.753) after multivariable adjustment. In contrast, no significant associations were observed in patients with HGI > −0.174 after adjustment. Within the lower-HGI subgroup, severely low HGI was associated with a higher risk of rehospitalization for HF and MACEs compared with mildly low HGI. Subgroup analyses were generally consistent with the main results.

Conclusions

In AMI patients without reduced LVEF, HGI showed a non-linear association with adverse outcomes, mainly in the lower-HGI range. These exploratory findings require prospective validation before clinical application.

Trial Registration: ClinicalTrials.gov Identifier: NCT04485988 and NCT04564365

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无左心室射血分数降低的急性心肌梗死患者的血红蛋白糖化指数和预后：一项多中心回顾性队列研究。

背景：血红蛋白糖化指数（HGI）在无左室射血分数（LVEF）降低的急性心肌梗死（AMI）患者中的预后价值尚不清楚。方法：本多中心回顾性队列研究纳入1706例无LVEF降低的AMI患者。HGI的计算方法为实测HbA1c减去预测HbA1c。使用限制三次样条（RCS）分析来评估HGI与预后之间的非线性关联，并确定截断值。采用分段Cox回归和亚组分析。主要终点是主要心血管不良事件（mace），定义为心力衰竭（HF）、复发性心肌梗死（MI）和心血管死亡的复合住院。结果：中位随访时间为3.86（2.30-4.98）年。RCS分析显示HGI与不良结局之间存在非线性关联，临界值为-0.174。在HGI≤-0.174的患者中，经多变量调整后，HGI升高与HF再住院（HR = 0.600, 95% CI: 0.464-0.776）、心肌梗死复发（HR = 0.599, 95% CI: 0.365-0.983）、心血管死亡（HR = 0.627, 95% CI: 0.458-0.859）、全因死亡（HR = 0.552, 95% CI: 0.428-0.713）和mace （HR = 0.603, 95% CI: 0.483-0.753）的风险降低相关。相比之下，调整后HGI > -0.174的患者未观察到显著相关性。在低HGI亚组中，与轻度低HGI相比，严重低HGI与HF和mace再住院的风险较高相关。亚组分析与主要结果基本一致。结论：在未降低LVEF的AMI患者中，HGI与不良结局呈非线性相关，主要在低HGI范围。这些探索性发现需要在临床应用前进行前瞻性验证。试验注册：ClinicalTrials.gov标识符：NCT04485988和NCT04564365。

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来源期刊

Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

2.20%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Diabetes (JDB) devotes itself to diabetes research, therapeutics, and education. It aims to involve researchers and practitioners in a dialogue between East and West via all aspects of epidemiology, etiology, pathogenesis, management, complications and prevention of diabetes, including the molecular, biochemical, and physiological aspects of diabetes. The Editorial team is international with a unique mix of Asian and Western participation. The Editors welcome submissions in form of original research articles, images, novel case reports and correspondence, and will solicit reviews, point-counterpoint, commentaries, editorials, news highlights, and educational content.