Prognostic value of glycated hemoglobin among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis

Abstract

Abstract:Many studies have shown the prognostic significance of glycated hemoglobin (HbA 1c ) for overall coronary artery disease (CAD). But less is known about the role that HbA 1c played in the prognosis of patients diagnosed with ST-segment elevation myocardial infarction (STEMI).Results from previous studies were controversial. Therefore, a meta-analysis was conducted to investigate whether admission HbA 1c level was a predictor of short-and longterm mortality rates among patients diagnosed with STEMI. Relevant literatures were retrieved from the electronic databases up to March 2016. Reference lists were hand searched to identify eligible studies. Articles were included if they provided sufficient information for the calculation of pooled relative risk (RR) and its corresponding 95% confidence interval (CI). Finally, we got 19 prospective studies involving a total of 35,994 STEMI patients to evaluate the associations between HbA 1c level and their in-hospital, 30-day and long-term mortality. Among STEMI patients, HbA 1c level was not significantly associated with in-hospital mortality (RR 1.20, 95% CI 0.95-1.53, p = 0.13). However, elevated HbA 1c level was positively associated with risk of 30-day and long-term mortality (for 30-day mortality, RR 1.25, 95% CI 1.03-1.52, p = 0.02; for long-term mortality, RR 1.45, 95% CI 1.20-1.76, p < 0.01). In conclusion, our findings suggested elevated HbA 1c level among STEMI patients was an indicator of 1.25-fold 30-day mortality risk and 1.45-fold long-term mortality risk, respectively. STEMI patients with high HbA 1c level should have their chronic glucose dysregulation under intensive control.

Associations Among Depression, Hemoglobin A1c Level, and Prognosis in Patients With Coronary Artery Disease: A Prospective Study

“…As for all the CAD populations, higher HbA1c led to an increased probability of MACE and composite endpoint events (HR for MACE and composite events: 1.97, 1.67) . This was consistent with the conclusions of many previous studies ( 23 , 26 , 37 , 38 ). What's more, when combined with clinical depression, the prognosis got even worse (HR for MACE and composite events: 2.9, 2.12) .…”

Evaluation of Myocardial Damage in Relation to HbA1c in Patients with Previously Unrecognized Diabetes Presenting with STEMI

“…Although the present study suggested that HbA1c may not be related to extent of infarct, in recent meta-analysis elevated HbA1c was associated with increased short-term mortality in ACS patients without DM history and without DM (17). In another meta-analysis elevated HbA1c level among STEMI patients was an indicator of 1.25-fold 30day mortality risk and 1.45-fold long-term mortality risk, respectively (19). Individuals with undiagnosed DM are at high risk of developing diabetic complications, including cardiovascular disease (20).…”

Prognostic value of HbA1c for in-hospital and short-term mortality in patients with acute coronary syndrome: a systematic review and meta-analysis

“…To our knowledge, this is the first systematic review regarding the predictive value of HbA1c for short-term mortality in ACS patients. Although there is a similar review regarding STEMI patients [57], it did not explain the heterogeneity explicitly. As unstable angina and NSTEMI share the same pathological process as STEMI, we took all the ACS patients into account in this systematic review.…”