Ghaffari Samad, Niafar Farhad, Separham Ahmad, Niafar Mitra, Pourafkari Leili, Nader Nader D
Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Ther Adv Cardiovasc Dis. 2015 Oct;9(5):305-13. doi: 10.1177/1753944715585500. Epub 2015 May 14.
The severity of coronary artery disease (CAD) is directly related to the quality of glucose control in diabetic patients. Additionally, mortality after an acute coronary syndrome is higher in patients with diabetes and it correlates to the level of glucose control. However, the role of higher gluconated hemoglobin in the process of coronary atherosclerosis and clinical outcome of acute myocardial infarction is unknown.
To evaluate the association of HbA1c level and severity of CAD and short-term outcomes of acute ST-elevation myocardial infarction (STEMI) in nondiabetics.
A total of 290 nondiabetic patients with STEMI were prospectively enrolled following their admission. Patients were stratified into 2 groups based on the median percent of HbA1c (⩽5.8% 'Low' and >5.8% 'High'). The severity of CAD based on the Califf scoring system, in-hospital mortality and morbidities of STEMI were compared between groups. Patients were followed for 1 year after discharge to assess readmission and mortality rate.
The severity score for CAD was significantly higher in the 'High' versus 'Low' HbA1c group (7.7 ± 2.7 and 5.5 ± 2.6, p = 0.001). A total of 15 patients died in both groups during the follow-up period. While in-hospital mortality was similar between the two groups, 12-month mortality was significantly higher in the 'High' group (7.7% versus 2.7%, p = 0.043). In addition, the rehospitalization rate within 1 year was 8.8% in the 'Low' group, which was significantly lower than 19.0% in the 'High' group (p = 0.016).
Among nondiabetic patients presenting with STEMI, the severity of CAD was higher in those with HbA1c level >5.8%; 1-year mortality and hospital readmission rates were also higher in this group of patients.
冠状动脉疾病（CAD）的严重程度与糖尿病患者的血糖控制质量直接相关。此外，糖尿病患者急性冠状动脉综合征后的死亡率更高，且与血糖控制水平相关。然而，较高糖化血红蛋白在冠状动脉粥样硬化过程及急性心肌梗死临床结局中的作用尚不清楚。
评估非糖尿病患者中糖化血红蛋白（HbA1c）水平与CAD严重程度及急性ST段抬高型心肌梗死（STEMI）短期结局的相关性。
共前瞻性纳入290例非糖尿病STEMI患者，患者入院后根据HbA1c中位数百分比分为两组（≤5.8%为“低”组，>5.8%为“高”组）。比较两组基于卡利夫评分系统的CAD严重程度、STEMI的院内死亡率和发病率。患者出院后随访1年，评估再入院率和死亡率。
“高”HbA1c组的CAD严重程度评分显著高于“低”HbA1c组（7.7±2.7和5.5±2.6，p = 0.001）。随访期间两组共有15例患者死亡。虽然两组院内死亡率相似，但“高”组12个月死亡率显著更高（7.7%对2.7%，p = 0.043）。此外，“低”组1年内再住院率为8.8%，显著低于“高”组的19.0%（p = 0.016）。
在非糖尿病STEMI患者中，HbA1c水平>5.8%者的CAD严重程度更高；该组患者一年死亡率和再入院率也更高。
