| Objective:To explore the predictive value of admission glycated hemoglobin levels for cardiovascular mortality and major adverse cardiovascular events(MACE) in hospital and one year in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention. Methods:Patients with acute ST segment elevation myocardial infarction were continuously screened. Hb A1 c levels were detected after admission. According to the standards of American Diabetes Association(ADA), patients were divided into three groups on the basis of the admission Hb A1 c levels: group A(Hb A1c≤5.6%, N = 46), group B(5.7≤Hb A1c≤6.4%, N = 64) and group C(Hb A1c≥6.5%, N = 64). Patients would be treated with primary percutaneous coronary intervention after admission.Baseline characteristics of the patients were recorded. The adverse cardiac events after myocardial infarction during hospitalization were recorded. The adverse cardiac events in the follow-up investigation of 1 year were noted by querying the records of readmission and inquiring the patients in outpatient and by telephone. Compare baseline characteristics of each group. Explore the predictive value of the level of admission Hb A1 c for the poor prognosis in hospital and one year in the patients. Results:1. The average level of Glycated hemoglobin was 6.70 ± 1.64%(range: 4.70%~13.40%) in the overall study population. Previous diabetes in the three groups are apparently different. In the overall study population, 37.4% of patients have previous diabetes. In patients without a history of diabetes, glycated hemoglobin of 13(11.9%) patients are above the ADA diagnostic criteria for diabetes. Fasting blood glucose of Group C is significantly higher than group A and group B. 14.3% of those that fasting blood glucose is in normal range have a result of Hb A1c≥6.5%.2. Although E/ e’ was not significantly different in the three groups, it is performed that there is pearson linear correlation between Hb A1 c and E/ e’(r = 0.339, p = 0.028). It shows that in three groups, patients of group C had three-vessel disease more often than groups A and B from coronary angiography results. At the time of discharge from the hospital, dual antiplatelet therapy, statins, nitrates, and other oral medication of the three groups were not significantly different after PCI. Treatment with intravenous diuretics and digitalis drugs in hospital is more often in group A than group C.3. No significant difference was seen in MACE rates in hospital between the groups. The incidence of acute left heart failure in group C was higher than group A(p = 0.008).4. Incidence of long-term major adverse cardiovascular events of each group is significantly different, and group C is higher than group A and B. The probability of severe heart failure during the one year follow up of group C is higher than group A and B. The factors, such as Killip class> 1, diabetes, fasting blood glucose, heart rate and Hb A1 c were included in multivariate COX regression analysis, and Killip class> 1(OR = 2.575, P = 0.036), Hb A1c(OR = 1.300, P = 0.009) were independent predictors of MACE within one year after STEMI, adjusted for other predictive factors. Conclusion:1.Glycosylated hemoglobin is not significantly with cardiac mortality and major adverse cardiovascular events in patients with acute myocardial infarction after percutaneous coronary intervention during hospitalization treatment.2. High glycated hemoglobin levels are linked with occurrence of heart failure in patients with acute myocardial infarction after percutaneous coronary intervention.3. Glycated hemoglobin is a independent predictor of major adverse cardiovascular events in STEMI patients one year after treated with primary PCI. |
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