TY - JOUR
T1 - Impact of elevated HbA1c on long-term mortality in patients presenting with acute myocardial infarction in daily clinical practice
T2 - insights from a 'real world' prospective registry of the Zwolle Myocardial Infarction Study Group
AU - Hermanides, Renicus S.
AU - Kennedy, Mark W.
AU - Kedhi, Elvin
AU - van Dijk, Peter R.
AU - Timmer, Jorik R.
AU - Ottervanger, Jan Paul
AU - Dambrink, Jan-Henk
AU - Gosselink, A. T. Marcel
AU - Roolvink, Vincent
AU - Miedema, Kor
AU - Slingerland, Robbert J.
AU - Koopmans, Petra
AU - Bilo, Henk J. G.
AU - van 't Hof, Arnoud W. J.
PY - 2020/9
Y1 - 2020/9
N2 - Background: Long-term clinical outcome is less well known in up to presentation persons unknown with diabetes mellitus who present with acute myocardial infarction and elevated glycosylated haemoglobin (HbA1c) levels on admission. We aimed to study the prognostic impact of deranged HbA1c at presentation on long-term mortality in patients not known with diabetes, presenting with acute myocardial infarction.Methods: A single-centre, large, prospective observational study in patients with and without known diabetes admitted to our hospital for ST-segment elevation myocardial infarction (STEMI) and non-STEMI. Newly diagnosed diabetes mellitus was defined as HbA1c of 48 mmol/l or greater and pre-diabetes mellitus was defined as HbA1c between 39 and 47 mmol/l. The primary endpoint was all-cause mortality at short (30 days) and long-term (median 52 months) follow-up.Results: Out of 7900 acute myocardial infarction patients studied, 1314 patients (17%) were known diabetes patients. Of the 6586 patients without known diabetes, 3977 (60%) had no diabetes, 2259 (34%) had pre-diabetes and 350 (5%) had newly diagnosed diabetes based on HbA1c on admission. Both short-term (3.9% vs. 7.4% vs. 6.0%, pConclusions: In the largest study to date, newly diagnosed or pre-diabetes was present in 33% of acute myocardial infarction patients and was associated with poor long-term clinical outcome. Newly diagnosed diabetes (HbA1c > 48 mmol/mol) is an independent predictor of long-term mortality. More attention to early detection of diabetic status and initiation of blood glucose-lowering treatment is necessary.
AB - Background: Long-term clinical outcome is less well known in up to presentation persons unknown with diabetes mellitus who present with acute myocardial infarction and elevated glycosylated haemoglobin (HbA1c) levels on admission. We aimed to study the prognostic impact of deranged HbA1c at presentation on long-term mortality in patients not known with diabetes, presenting with acute myocardial infarction.Methods: A single-centre, large, prospective observational study in patients with and without known diabetes admitted to our hospital for ST-segment elevation myocardial infarction (STEMI) and non-STEMI. Newly diagnosed diabetes mellitus was defined as HbA1c of 48 mmol/l or greater and pre-diabetes mellitus was defined as HbA1c between 39 and 47 mmol/l. The primary endpoint was all-cause mortality at short (30 days) and long-term (median 52 months) follow-up.Results: Out of 7900 acute myocardial infarction patients studied, 1314 patients (17%) were known diabetes patients. Of the 6586 patients without known diabetes, 3977 (60%) had no diabetes, 2259 (34%) had pre-diabetes and 350 (5%) had newly diagnosed diabetes based on HbA1c on admission. Both short-term (3.9% vs. 7.4% vs. 6.0%, pConclusions: In the largest study to date, newly diagnosed or pre-diabetes was present in 33% of acute myocardial infarction patients and was associated with poor long-term clinical outcome. Newly diagnosed diabetes (HbA1c > 48 mmol/mol) is an independent predictor of long-term mortality. More attention to early detection of diabetic status and initiation of blood glucose-lowering treatment is necessary.
KW - Diabetes mellitus
KW - HbA1c
KW - (primary) percutaneous coronary intervention
KW - acute myocardial infarction
KW - NONDIABETIC PATIENTS
KW - ADMISSION GLUCOSE
KW - PROGNOSTIC VALUE
KW - ANGIOGRAPHIC ASSESSMENT
KW - PRIMARY ANGIOPLASTY
KW - GLYCEMIC CONTROL
KW - HEMOGLOBIN A1C
KW - REPERFUSION
KW - HBA(1C)
KW - EVENTS
U2 - 10.1177/2048872619849921
DO - 10.1177/2048872619849921
M3 - Article
C2 - 31124695
SN - 2048-8726
VL - 9
SP - 616
EP - 625
JO - European Heart Journal: Acute Cardiovascular Care
JF - European Heart Journal: Acute Cardiovascular Care
IS - 6
ER -