The Clinical Value Of The Plasma Glycosylate Hemoglobin In Patients With Acute Myocardial Infarction

Objective: To study the relation of the Hb_Alc to theraputic strategies, risk factors, outcome and prognosis of acute myocardial infarction(AMI). As well as the predictive value of Hb_Alc and other risk factors in the occurrence of AMI.Methods: 197 patients with AMI treated in the department of cardiology of the 3rd Hospital of Tianjin from August 1, 2005 to December 31, 2006 were divided into the normal Hb_Alc group and elevated Hb_Alc group. Each group was divided into 3 subgroups according to the therapies (conservative, thrombolytic, percutaneous coronary intervention). They were conservative group of normal Hb_Alc, conservative group of elevated Hb_Alc, thrombolytic group of normal Hb_Alc, thrombolytic group of elevated Hb_Alc, PCI group of normal Hb_Alc, PCI group of elevated Hb_Alc. Venous blood routine examinations were done in the acute period and the next day, and echocardiographic examination or evaluations were done in the acute period on the same time in all patients.Results: There was no significant statistical difference in age, male/female, history of myocardial infarction, history of hypertension, smoking, other risk factors and history of coronary artery disease (P＜0.05) between the normal group and the elevated Hb_Alc group. But the percentage of the patients with diabetes mellitus in the elevated Hb_Alc group was higher than the normal group(P＜0.001). The blood sugar value(P=0.000), diameter of left atrium(LAD) during the period of treatment(P=0.004), left ventricular ejection faction(LVEF)(P=0.008) showed signifiant differences between normal and abnormal Hb_Alc group. But there was no significant difference(P＞0.05) between the normal group and the elevated Hb_Alc group in age, hs-CRP, systolic pressure, serum creatinine, HDL, TnT, left ventricular end-systolic diameter(LVSD), fibrinogen(FIB). Killip grades of cardiac function in the elevated Hb_Alc group was higher than that in normal group (P=0.014). The ratio of improvement in elevated Hb_Alc group was lower than that one in normal group, but the mortality was higher than the latter(P=0.014). The recurrence of complications (acute left ventricular failure, atrial fibrillation, ventricular fibrillation, A-V block, hypotension, cardiogenic death) in normal group were less than them in elevated Hb_Alc group (P=0.001). There is obviously relationship between the level of Hb_Alc and the heart function of NYHA when these patients were followed up. In this research, 19 patients died of cardiogenic within six months in the whole 197 patients followed up. NYHA grade in elevated Hb_Alc group was higher than those in normal group (P=0.019). But there was no relation between the level of Hb_Alc and the infarction region (P=0.195). According to the different therapy, the outcome was apparently influenced with the increased Hb_Alc level (P＜0.05) in the conservative group. But there was no significant difference between the thrombolitic group and the PCI group (P＞0.05). After thepatients were further subdivided into conservative group and reperfusion group, the outcome in the reperfusion group is better than that in conservative group within elevated Hb_Alc patients(P=0.023). There was statistical significance between the normal Hb_Alc conservative group and the elevated Hb_Alc conservative group (P=0.029). But there was no significant difference between conservative group and reperfusion group with in the same level of Hb_Alc (P＞0.05). To divide the cases into conservative group, thromboltic group, PCI group, the blood sugar value in elevated Hb_Alc patients was higher than it in normal patients(P=0.000)in conservative group. Left ventricular ejection faction in the elevated patients was lower than it in the normal patients (P=0.001). Killip grades (P=0.003) in elevated Hb_Alc patients was remarkable higherthan that in normal Hb_Alc patients and the cardiac function of NYHA when they were followed up is less than the latter (P=0.004). The TnT(P=0.027) and the fibrinogen(FIB)(P=0.004)in the patients of elevated Hb_Alc is higher than those in normal ones. In PCI group, the blood sugar value (P=0.002) and left ventricular end-systolic diameter(LVSD) (P=0.039) in elevated Hb_Alc patients is higher than that in the normal ones. Through the research, the patients outcome and prognosis were influenced by the factors just as Hb_Alc(P=0.014), blood sugar(P=0.000), smoking (P=0.016), history of diabetes mellitus (P=0.041), serum creatinine (P=0.003), TnT (P=0.O17), left atrium diameter (LAD) (P=0.000), FIB(P=0.027), complication (P=0.000), Killip grades (P=0.000), follow-up NYHA grades(P=0.000) and so on. Through Spearman' s correlation analysis, a positive correlation was showed between the prognosis of patients with AMI and the level of Hb_Alc, admission blood sugar, serum creatinine, TnT, LAD, LVDD, LVSD, FIB, complication, Killip grades, follow-up NYHA grades (r=0.158～0.746, P=0.000～0.027), a negative correlation between LVEF and prognosis (r=-0.232, P=0.001), no correlation between prognosis and hs-CRP, systolic pressure, HDL-C and different therapy. According to the Hb_Alc, normal group (≤6.5ï¼…), moderate elevated group, (≤9ï¼…and＞6.5ï¼…), severe elevated group(＞9ï¼…) were defined, we compared the outcome of three groups, 4 cases died in the 94 cases of the normal group, 12 cases died in 81 cases of moderate elevated group, 3 cases died in 22 cases of severe elevated group. There was significant statis-tical difference within three groups (X²=0.020, P=0.049), (r=0.151, P=0.034).Conclusion:1.A correlation was showed between Hb_Alc and blood sugar, LAD, LVSD, LVEF, complication, Killip grades of cardiac function, NYHA grades of follow-up cardiac function, outcome. The prognosis of AMI could be improved significantly by the control of Hb_Alc level.2. The factors related to patients prognosis include Hb_Alc, blood sugar, smoking, history of diabetes mellitus, serum creatinine, TnT, LAD, LVDD, LVSD, LVEF, FIB, complication, Killip grades, follow-up NYHA grades, etc. But there is no correlations between prognosis and sex, age, history of myocardial infarction, hypertension, history of coronary artery disease, hs-CRP, HDL-C.3. The incidence of non-ST-segment elevation myocardial infarction is higher in Hb_Alc elevated group.4. Hb_Alc is the predict factor of ocurrence and outcomes of AMI.