No association between hemoglobin A1c and in-hospital mortality in patients with diabetes and acute myocardial infarction

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• 作者：Kathryn A. Britton MD^a ; Vikas Aggarwal MD^b ; Anita Y. Chen MS^c ; Karen P. Alexander MD^c ; Ezra Amsterdam MD^d ; Elizabeth Fraulo RN ; BSN^c ; Paul Muntner PhD^e ; Laine Thomas PhD^c ; Darren K. McGuire MD ; MHSc^f ; Stephen D. Wiviott MD^a ; Matthew T. Roe MD ; MHS^c ; Ulrich K. Schubart MD^g ; Caroline S. Fox MD ; MPH^h ; ⁱ ; ^{foxca@nhlbi.nih.gov}
• 刊名：American Heart Journal
• 出版年：2011
• 出版时间：April 2011
• 年：2011
• 卷：161
• 期：4
• 页码：657-663.e1
• 全文大小：178 K

文摘

Background

Patients with diabetes have increased in-hospital mortality following acute myocardial infarction (AMI), with studies suggesting higher risk with both hypoglycemia and hyperglycemia. We assessed whether a J-shaped relation exists between hemoglobin A1c (A1C) in patients with diabetes and AMI.

Methods

We assessed the associations between A1C and in-hospital mortality using data from a nationwide sample of AMI patients who had both prior diabetes and measurement of A1C (N = 15,337).

Results

When evaluated continuously, we observed no evidence of a J-shaped relation between A1C and in-hospital mortality in multivariable analysis (test for linearity P = .89). Patients with lowest (<5.5 % ) and highest A1C (≥9.5 % ) had a crude mortality rate of 4.6 % and 2.8 % , respectively, compared with 3.8 % among those in the referent A1C category (6.5 % to <7 % ). In multivariable regression, we observed no association between low A1C (<5.5 % , odds ratio 0.81, 95 % CI 0.47-1.39) or high A1C (A1C ≥9.5, odds ratio 1.31, 95 % CI 0.94-1.83) and mortality as compared with the referent group. These findings can only be generalized to the subset of patients with diabetes who had A1C assessed during their hospitalization; these patients tended to be healthier than those in whom A1C was not assessed.

Conclusion

In this large contemporary cohort of patients with diabetes presenting with AMI, we did not observe a J-shaped association between A1C and mortality.