Cicek Gokhan, Uyarel Huseyin, Ergelen Mehmet, Ayhan Erkan, Abanonu Gul Babacan, Eren Mehmet, Gibson Charles Michael
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
Coron Artery Dis. 2011 May;22(3):131-7. doi: 10.1097/MCA.0b013e328342c760.
We sought to determine the effect of hemoglobin A1c (HbA1c) on the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
Diabetes mellitus (DM) can be diagnosed from a level of at least 6.5% on two separate occasions according to the American Diabetes Association (ADA) definition, which was updated in 2010. No data are available for the value of HbA1c in patients with STEMI treated with primary PCI.
A total of 374 consecutive patients with STEMI (mean age: 55.9±12.6 years, 318 men), undergoing primary PCI between December 2009 and June 2010, were prospectively enrolled in this study. Blood samples for HbA1c were obtained on the first 24 h after admission. In-hospital follow-up was performed. By using new ADA criteria, patients were classified into three groups: group I (HbA1c ≤5.6%, n=112); group II (HbA1c: 5.7-6.4%, n=180); and group III (HbA1c ≥6.5%, n=82).
In-hospital mortality was higher in group III (11%) compared with group II (2.8%) and group I (0.9%; P=0.001). Major adverse cardiac events in the hospital were also higher in group III (12.2%) compared with other groups (group II, 5.6% vs. group I, 0.9%, P=0.003). After adjusting the baseline characteristics, HbA1c remained a strong independent predictor of the in-hospital mortality (odds ratio: 1.412; 95% confidence interval: 1.031-1.935, P=0.03). Hospital stay was also longer in group III than others (P=0.007). A total of 196 (63.6%) patients without a history of diabetes mellitus had elevated HbA1c of more than or equal to 5.7%, with 31 (10.1%) of them having HbA1c of more than or equal to 6.5%.
HbA1c is an independent predictor of the in-hospital mortality in STEMI treated with primary PCI. Apart from prognostic value, high HbA1c could be used for diabetes mellitus diagnosis, which is supported by ADA definitions.
我们试图确定糖化血红蛋白（HbA1c）对ST段抬高型心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PCI）结局的影响。
根据美国糖尿病协会（ADA）2010年更新的定义，糖尿病（DM）可通过两次独立检测糖化血红蛋白水平至少为6.5%来诊断。目前尚无关于接受直接PCI治疗的STEMI患者HbA1c值的相关数据。
本研究前瞻性纳入了2009年12月至2010年6月期间连续374例接受直接PCI治疗的STEMI患者（平均年龄：55.9±12.6岁，男性318例）。入院后24小时内采集HbA1c血样。进行住院期间随访。根据新的ADA标准，将患者分为三组：I组（HbA1c≤5.6%，n = 112）；II组（HbA1c：5.7 - 6.4%，n = 180）；III组（HbA1c≥6.5%，n = 82）。
III组的住院死亡率（11%）高于II组（2.8%）和I组（0.9%；P = 0.001）。III组的院内主要不良心脏事件发生率（12.2%）也高于其他组（II组为5.6%，I组为0.9%，P = 0.003）。在调整基线特征后，HbA1c仍然是住院死亡率的强有力独立预测因素（比值比：1.412；95%置信区间：1.031 - 1.935，P = 0.03）。III组的住院时间也比其他组更长（P = 0.007）。共有196例（63.6%）无糖尿病病史的患者HbA1c升高至5.7%及以上，其中31例（10.1%）的HbA1c达到6.5%及以上。
HbA1c是接受直接PCI治疗的STEMI患者住院死亡率的独立预测因素。除了具有预后价值外，高HbA1c还可用于糖尿病诊断，这得到了ADA定义的支持。
