Effect of admission glycometabolic state on clinical outcome in non diabetic subjects with acute st segment elevation myocardial infarction

Background and aim

Glycosylated hemoglobin (HbA1c) is a more stable and accurate parameter of the glycometabolic state than fasting glycemia. However, its role in predicting the prognosis in acute myocardial infarction patients remains unclear with conflicting results from the available data. This study evaluates the effect of admission HbA1c as a parameter of the glycometabolic state on the clinical outcome in non diabetic acute st segment elevation myocardial infarction (STEMI) patients.

Method

Between June 2012 and December 2014, 208 consecutive STEMI non diabetic patients who underwent primary percutaneous coronary intervention (PPCI) were enrolled. Patients were divided according to the HbA1c level into 2 groups 112 patients in group I (HbA1c ⩽ 5.6%) and 96 patients in group II (HbA1c 5.7–6.4%). In hospital and at 6 months major adverse cardiac outcome (MACE) was calculated.

Results

Mean age was 55.9 ± 7.12 years, 149 were men and there was no significant difference regarding baseline characteristics. Post PPCI TIMI III flow was higher in group I (p = 0.016), angiographic no reflow was higher in group 2 (p = 0.003). No significant difference regarding in hospital MACE (p = 0.44). At 6 month follow up MACE was significantly higher in group 2 (p < 0.001) and this mainly due to higher incidence of target lesion revascularization (TLR) in group 2 (p < 0.001). Multivariate analysis showed that HbA1c is significantly associated with 6 months MACE (hazard ratio 1.9; p = 0.022).

Conclusion

Abnormal glycometabolic state assessed by HbA1c at admission in non diabetic STEMI patients was associated with higher MACE incidence at 6 months follow up.