Long Term Prognostic Value of HbA1C in Acute Myocardial Infarction Patients without Known Diabetes = Long Term Prognostic Value of HbA1C in Acute Myocardial Infarction Patients without Known Diabetes

다국어 초록 (Multilingual Abstract)

Background: The prognostic role of glycosylated hemoglobin (HbA1C) in non-diabetic (non-DM) patients with acute myocardial infarction (AMI) is still controversial. We evaluated the prognostic role of HbA1C in AMI patients without previously known diabetes. Methods: From January 2008 to August 2011, 3,292 in AMI patients with non-DM [65.6±13.1 years, 2,460 men (74.8%)] who underwent laboratory testing of HbA1C were enrolled retrospectively. Patients were divided into two groups by HbA1C [Group 1 ≤ 6.5%, n=2,864 (87%); Group 2 > 6.5%, n=428 (13%)]. The primary end point was composite major adverse cardiac events (MACEs) including all cause death, cardiac death, re-MI, and revascularization of target or non-target vessel during 12 months follow up. Results: Patients of in-hospital all cause death and cardiac death were 202 [169 (6.0%) vs. 33 (6.8%), p>0.05) and 145 [124 (4.4%) vs. 21 (4.3%), p>0.05], respectively. BMI (24.0±3.1 vs. 24.9±3.6), blood glucose (145±55 vs. 207±90 mg/dL), total cholesterol (184±44 vs. 196±47 mg/dL), triglyceride (121±88 vs. 157±118 mg/dL), LDL (118±39 vs. 127±41 mg/dL) and hs-CRP (5.35±20.3 vs. 8.76±34.9 mg/dL) were higher and HDL (44.4±14.7 vs. 42.2±11.7 mg/dL) was lower in group 2 (p of all variables < 0.01). The incidence of hyperlipidemia (9.2% vs. 12.4%, p=0.036), obesity (BMI ≥ 30, 3.3% vs. 8.2%, p<0.01), current smoker (44.7% vs. 50.2%, p=0.032), and left ventricular (LV) dysfunction (ejection fraction<40%, 11.3% vs. 15.4%, p=0.021) were more frequent in group 2. There were no significant difference in clinical outcomes at 12 months. In subgroup analysis (group 1 was divided by 5.5% of HbA1C), there were no significant difference in short and long term clinical outcomes. Old Age (age ≥ 65 years), high Killip class (III & IV), LV dysfunction, and renal insufficiency (GFR <60 mL/min) were independent predictors of 12 months composite MACEs. Conclusion: Korean AMI patients with non-DM and HbA1C > 6.5% were not associated with worse outcomes during 12 months follow up.