• Y Liu, Y-M Yang, J Zhu, H-Q Tan, Y Liang, and J-D Li.
• Chinese Academy of Medical Sciences, Beijing, China.
• Diabet. Med. 2012 Dec 1;29(12):1493-500.

AimsTo assess the prognostic impact of HbA(1c) and blood glucose level in patients with acute ST-segment elevation myocardial infarction and without diabetes. The relationship between HbA(1c) and acute hyperglycaemia was also explored.Methods And ResultsWe evaluated 4793 ST-segment elevation myocardial infarction patients with baseline HbA(1c) and three glucose measurements in the first 24 h. First, patients were stratified into quintiles by HbA(1c) and mean/admission glucose level. A total of 373 deaths (7.8%) occurred at 7 days, and 486 deaths (10.1%) occurred at 30 days. There were no significant differences in 7- and 30-day mortality, and major adverse cardiovascular event rates across HbA(1c) quintiles (< 34.4 mmol/mol (5.3% ), 34.4 to < 37.7 mmol/mol (5.6%), 37.7 to < 41.0 mmol/mol (5.9% ), 41.0 to < 47.5 mmol/mol (6.5%), and ≥ 47.5 mmol/mol; P for trend > 0.05). The risks of mortality and major adverse cardiovascular events were significantly increased in patients with higher glucose quintiles and lower quintile compared with the middle quintile after multivariable adjustment (P < 0.001). Patients were then reclassified into four groups according to mean/admission glucose and HbA(1c) levels. The group with elevated glucose and non-elevated HbA(1c) was associated with the highest mortality and major adverse cardiovascular event risk (P < 0.001).ConclusionsUnlike acute hyperglycaemia, an elevated HbA(1c) level was not a risk factor for short-term outcomes in ST-segment elevation myocardial infarction patients without diabetes. Patients with acute hyperglycaemia and non-elevated HbA(1c) were associated with the worst prognosis. That suggests chronic glycaemic control/HbA(1c) level may help to recognize stress-induced hyperglycaemia and identify high-risk patients.© 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

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