Ygal Plakht
Frequent fluctuations of hemoglobin A1c (HbA1C) values are independent predictors of diabetic complications and patient outcomes. However, data regarding prognosis depending on the long-term changes in HbA1C among patients after acute myocardial infarction (AMI) are scarce. We evaluated the prognostic significance of HbA1C levels and their changes among diabetic patients after non-fatal AMI. Patients with diabetes mellitus (DM) admitted with AMI (2002-2017) and survived >1year were evaluated. All the results of HbA1C values during the follow-up period (up to 10-years after discharge) were obtained and analyzed. The changes (??) of HbA1C were calculated for all pairs of tests in each patient. The time interval of ??HbA1C values was classified as rapid (<1 year) and slow (?1 year) change. The outcome was all-cause mortality. A total of 4,066 patients were analyzed, mean age 66.4±11.9 years, 36% females. A U-shaped association was observed between HbA1C and mortality: adjOR=1.887 and adjOR=1.302 for HbA1C <5.5% and ?8.0% respectively, as compared with 5.5-6.5% (p<0.001). A U-shaped independent association between ??HbA1C and mortality was found: adjOR=2.376 and adjOR=1.340 for the groups of <-2.5% and ?2.5% HbA1C changes, respectively (p<0.001 for each), as compared to the group of minimal ??HbA1C (±0.5%). A rapid increase in HbA1C (but not decrease) was associated with a greater risk for mortality. HbA1C values and their changes are significant independent prognostic markers for long-term mortality with a U-shaped association following AMI among DM patients. Thus, ??HbA1C and its timing, in addition to absolute HbA1C values, should be monitored among these patients.
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