HbA1c: A Marker for Severity of Acute Myocardial Infarction

ABSTRACT

Introduction: Diabetes mellitus is considered a disease with a major impact on the vascular tree with both microvascular and macrovascular complications. Hyperglycaemia is independent risk factor for cardiovascular diseases. HbA1c could be considered as a good marker for glycemic control. Recent reports have found that elevated HbA1c levels are also predictive for cardiovascular disease and mortality. Present study was undertaken to find out the correlation between HbA1c levels and complications and outcome in patients of acute myocardial infarction. Materials and methods: Present prospective observational study was conducted on 200 patients admitted to the medical wards in hospital with acute myocardial infarction with or without diabetes mellitus. After a detailed history and physical examination, HbA1c, lipid profile, cardiac enzymes, ECG and echocardiogram were performed in all patients. The patients were then divided into two groups based on the HbA1c levels i.e. good glycemic control (HbA1c< 7%) and poor glycemic control (HbA1c>/= 7%).Data was analysed using SPSS software ver. 21 using appropriate statistical tests. P-value of less than 0.05 was taken as level of significance Results: Poor glycemic control was seen in 52.5% patients. No difference was observed between the groups with respect to gender distribution, duration of hospital stay and patient’s outcome. Past history of MI was found to be significantly associated with poor glycemic control (53.3% vs 38.9%). On comparing the association of outcome in high risk groups as per glycemic control, we observed that poor outcome in MI was significantly associated with elderly population (16.9% vs 3.5%; p< 0.05). Conclusions: In patients with age greater than 60 years, the occurrence of higher HbA1c levels is found to be associated with increased incidence of mortality. So, high HbA1c in elderly population should be considered a risk factor for mortality and hence active management should be done to keep HbA1c level strictly below 7 in this population.