Prognostic Value Of Hemogologbin Alc In Patients With Acute Coronary Syndrome

Objective:To investigate the effect of HbAlc on the clinical outcomes in.patients with acute coronary syndrome.Methods:Consecutive 273 patients hospitalized at HuaShan hospital from June 2006 to October 2008 with acute coronary syndrome confirmed by coronary arteriography were included in this retrospective study. Echocardiograph,fasting blood sugar (within 24 hours),glycosylated hemoglobin,creatinine,serum lipid and routine blood tests were investigated. The predefined end points were all-cause mortality (primary end point)and composite end points which including all-cause mortality and coronary revascularization. All patients with or without diabetes were stratified into 2 groups to separately assesse the survival as a function of HbAlc.Results:Among the total of 273 patients, mean follow-up time was 2.8 years and mean age was 67.5±10.2 years. HbAlc level was an independent predictor of outcomes except EF and eGFR in multivariate analyses A 1%absolute increase in HbAlc level at baseline resulted in a 33.3% increase in mortality and a 34.5%increase in composite end points Compared with group with the glycated haemoglobin (HbA1c)<6%,the risk of all-cause mortality in group with the glycated haemoglobin (HbAlc)≥6%was increased by 176%(HR=2.763) and the risk of composite end points (all-cause mortality plus coronary revascularization) was increased by 110%(HR=2.103).HbAlc level was an independent predictor of mortality and composite end points in the this group patients of ACS. Among 112 patients with diabetes, HbAlc level and eGFR were the independent predictors of outcomes, a 1%increace in HbAlc level at baseline was associated with a 66.2%increace in mortality and a 53.1%increace in composite end points. Compared with group with the HbAlc< 8.6%, the risk of all-cause mortality was 4.76 times higher (HR=5.763), and the risk of composite end points (all-cause mortality plus coronary revascularization) was 3.84 times higher (HR=4.841) in group with the HbAlc≥8.6%. HbAlc level was an independent predictor of mortality and composite end points in patients with diabetes. Among 161 patients without diabetes, compared with group with the glycated haemoglobin (HbAlc) <6%, the risk of all-cause mortality were 2.66 times higher (HR=3.661) in group with the glycated haemoglobin (HbAlc)≥6%, HbAlc level was an independent predictor of mortality in ACS patients without diabetes. Conclusions:HbAlc level may be an independent predictor of all-cause mortality and composite end points (all-cause mortality plus coronary revascularization) in the total ACS patients no matter with or without diabetes. Mesaurement of HbAlc could provide more prognostic information for patients with acute coronary syndromes.