BACKGROUND: Elevated admission glucose level is a strong predictor of short-term adverse outcome in patients with acute coronary syndrome (ACS). However, the prognostic value of diabetic control (ie, hemoglobin A(1c) levels) in patients with ACS is still undefined. HYPOTHESIS: Hemoglobin A(1c) level may predict short-term outcome in patients with ACS. METHODS: We conducted a retrospective study with prospective follow-up in 317 diabetic patients with ACS. Patients were stratified into 2 groups based on HbA(1c) level, checked within 8 weeks of the index admission (optimal control group, HbA(1c) ≤7%; suboptimal control group, HbA(1c) >7%). All patients were followed up prospectively for major adverse cardiovascular events (MACE) and mortality for 6 months. Short-term clinical outcomes were also compared between the 2 study groups. RESULTS: In our cohort, 27.4%, 46.4%, and 26.2% patients had unstable angina, non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction, respectively. In-hospital mortality was similar in both HbA(1c) groups (3.37% vs 2.88%, P = 0.803). Six-month MACE was also similar (26.40% vs 26.47%, P = 0.919). All-cause mortality, cardiovascular mortality, symptom-driven revascularization, rehospitalization for angina, and hospitalization for heart failure were also similar in both groups. The hazard ratios for 6-month MACE and individual endpoints were also similar in both groups. CONCLUSIONS: This study suggests that HbA(1c) levels before admission are not associated with short-term cardiovascular outcome in diabetic patients subsequently admitted with ACS.
BACKGROUND: Elevated admission glucose level is a strong predictor of short-term adverse outcome in patients with acute coronary syndrome (ACS). However, the prognostic value of diabetic control (ie, hemoglobin A(1c) levels) in patients with ACS is still undefined. HYPOTHESIS: Hemoglobin A(1c) level may predict short-term outcome in patients with ACS. METHODS: We conducted a retrospective study with prospective follow-up in 317 diabeticpatients with ACS. Patients were stratified into 2 groups based on HbA(1c) level, checked within 8 weeks of the index admission (optimal control group, HbA(1c) ≤7%; suboptimal control group, HbA(1c) >7%). All patients were followed up prospectively for major adverse cardiovascular events (MACE) and mortality for 6 months. Short-term clinical outcomes were also compared between the 2 study groups. RESULTS: In our cohort, 27.4%, 46.4%, and 26.2% patients had unstable angina, non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction, respectively. In-hospital mortality was similar in both HbA(1c) groups (3.37% vs 2.88%, P = 0.803). Six-month MACE was also similar (26.40% vs 26.47%, P = 0.919). All-cause mortality, cardiovascular mortality, symptom-driven revascularization, rehospitalization for angina, and hospitalization for heart failure were also similar in both groups. The hazard ratios for 6-month MACE and individual endpoints were also similar in both groups. CONCLUSIONS: This study suggests that HbA(1c) levels before admission are not associated with short-term cardiovascular outcome in diabeticpatients subsequently admitted with ACS.
Authors: Sridharan Raghavan; Wenhui G Liu; Seth A Berkowitz; Anna E Barón; Mary E Plomondon; Thomas M Maddox; Jane E B Reusch; P Michael Ho; Liron Caplan Journal: J Gen Intern Med Date: 2020-04-24 Impact factor: 5.128