Changes over Time in Hemoglobin A1C (HbA_1C) Levels Predict Long-Term Survival Following Acute Myocardial Infarction among Patients with Diabetes Mellitus

Abstract

Frequent fluctuations of hemoglobin A1c (HbA1C) values predict patient outcomes. However, data regarding prognoses 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 changes among diabetic patients (n = 4066) after non-fatal AMI. All the results of HbA1C tests up to the 10-year follow-up were obtained. The changes (∆) of HbA1C were calculated in each patient. The time intervals of ∆HbA1C values were classified as rapid (1C 1C = −2.5–(−2%) categories. A U-shaped association was observed between HbA1C and mortality: adjOR = 1.887 and adjOR = 1.302 for HbA1C p 1C was associated with the outcome (U-shaped): adjOR = 2.376 and adjOR = 1.340 for the groups of 1C, respectively, as compared to minimal ∆HbA1C (±0.5%) (p 1C (but not decrease) was associated with a greater risk of mortality. HbA1C values and their changes are significant prognostic markers for long-term mortality among AMI-DM patients. ∆HbA1C and its timing, in addition to absolute HbA1C values, should be monitored.

Keywords

• diabetes mellitus
• acute myocardial infarction
• hemoglobin A1c
• prognosis
• mortality