Long-term prognostic value of admission haemoglobin A1c (HbA1c) levels in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
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[H2 BAŞLIK]: Introduction to HbA1c and Acute Coronary Syndrome
Numerous clinical studies have documented the diagnostic and prognostic significance of haemoglobin A1c (HbA1c) levels in patients diagnosed with acute coronary syndrome. Despite its established role in general cardiology, the specific short- and long-term prognostic utility of HbA1c levels in patients with ST elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) remains a subject of clinical debate. This study aims to clarify these associations to improve patient risk stratification.
[H2 BAŞLIK]: Study Objective and Research Aim
The primary objective of this research was to investigate whether admission HbA1c levels serve as a reliable prognostic indicator for cardiovascular outcomes. The study focused on in-hospital, short-term, and long-term cardiovascular (CV) mortality, as well as major adverse cardiovascular events (MACE). The target population consisted specifically of STEMI patients who were treated with primary PCI.
[H2 BAŞLIK]: Materials and Methods
This prospective study analyzed data from 443 consecutive patients with STEMI who underwent primary PCI between September 2010 and July 2012. To ensure a comparative analysis, patients were categorized into three distinct groups based on their HbA1c levels at the time of admission:
| Hasta Grubu | HbA1c Seviyesi |
|---|---|
| Group I | HbA1c ≤ 5.6% |
| Group II | HbA1c 5.7–6.4% |
| Group III | HbA1c ≥ 6.5% |
Clinical follow-ups were conducted to monitor CV events at three critical intervals: during the in-hospital stay, at the 1-month mark, and after 1 year.
[H2 BAŞLIK]: Key Findings and Statistical Analysis
The research revealed a significant correlation between admission HbA1c levels and 1-year primary clinical outcomes, including CV mortality, non-fatal reinfarction, and stroke (p = 0.037). Furthermore, multivariate analysis identified several factors as independent predictors of long-term cardiovascular mortality:
- Age: Hazard Ratio 1.081 (95% CI: 1.020–1.146; p = 0.009)
- Killip class > 1: Hazard Ratio 4.182 (95% CI: 1.171–14.935; p = 0.028)
- Left ventricular ejection fraction (LVEF): Hazard Ratio 0.832 (95% CI: 0.752–0.920; p < 0.001)
[H2 BAŞLIK]: Conclusion: The Prognostic Impact of HbA1c
In conclusion, this study demonstrates that elevated admission HbA1c levels are directly associated with increased rates of major adverse cardiovascular events (MACE). Patients with higher HbA1c levels undergoing primary PCI for STEMI face a greater risk of mortality, non-fatal reinfarction, and stroke. These findings highlight the importance of monitoring HbA1c as a critical prognostic tool in clinical practice for STEMI management.
