Plakht Ygal, Gilutz Harel, Shiyovich Arthur
Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel.
Department of Emergency Medicine, Soroka University Medical Center, Beer Sheva 84101, Israel.
J Clin Med. 2021 Jul 22;10(15):3232. doi: 10.3390/jcm10153232.
Frequent fluctuations of hemoglobin A1c (HbA) values predict patient outcomes. However, data regarding prognoses depending on the long-term changes in HbA among patients after acute myocardial infarction (AMI) are scarce. We evaluated the prognostic significance of HbA levels and changes among diabetic patients ( = 4066) after non-fatal AMI. All the results of HbA tests up to the 10-year follow-up were obtained. The changes (∆) of HbA were calculated in each patient. The time intervals of ∆HbA values were classified as rapid (<one year) and slow (≥one year) changes. The outcome was all-cause mortality. The highest mortality rates of 53.8% and 35.5% were found in the HbA < 5.5-7% and ∆HbA = -2.5-(-2%) categories. A U-shaped association was observed between HbA and mortality: adjOR = 1.887 and adjOR = 1.302 for HbA < 5.5% and ≥8.0%, respectively, as compared with 5.5-6.5% ( < 0.001). Additionally, ∆HbA was associated with the outcome (U-shaped): adjOR = 2.376 and adjOR = 1.340 for the groups of <-2.5% and ≥2.5% ∆HbA, respectively, as compared to minimal ∆HbA (±0.5%) ( < 0.001). A rapid increase in HbA (but not decrease) was associated with a greater risk of mortality. HbA values and their changes are significant prognostic markers for long-term mortality among AMI-DM patients. ∆HbA and its timing, in addition to absolute HbA values, should be monitored.
糖化血红蛋白（HbA）值的频繁波动可预测患者的预后。然而，关于急性心肌梗死（AMI）后患者HbA长期变化对预后影响的数据却很稀少。我们评估了非致死性AMI后糖尿病患者（n = 4066）HbA水平及变化的预后意义。获取了直至10年随访期内所有的HbA检测结果。计算了每位患者HbA的变化值（∆）。将∆HbA值的时间间隔分为快速变化（<1年）和缓慢变化（≥1年）。观察终点为全因死亡率。在HbA<5.5 - 7%和∆HbA = -2.5 - (-2%)类别中，死亡率最高，分别为53.8%和35.5%。观察到HbA与死亡率之间呈U形关联：与5.5 - 6.5%相比，HbA<5.5%和≥8.0%时的校正比值比（adjOR）分别为1.887和1.302（P<0.001）。此外，∆HbA与观察终点也呈U形关联：与最小∆HbA（±0.5%）相比，∆HbA<-2.5%和≥2.5%组的adjOR分别为2.376和1.340（P<0.001）。HbA快速升高（而非降低）与更高的死亡风险相关。HbA值及其变化是AMI合并糖尿病患者长期死亡率的重要预后标志物。除了绝对HbA值外，还应监测∆HbA及其变化时间。
