| 이민구¹ , 김수현² , 조장현² , 정명호¹ , 안영근¹ , 김영조³ , 안태훈⁴ , 권현철5외 한국인급성심근경색증등록연구자(Korea Working Group on Myocardial Infarction Investigators) |
Background: The optimal glycosylated hemoglobin (HbA1c) level in diabetic patients remained to be controversial era, but may be especially important in predicting the prognosis of diabetic patients with acute myocardial infarction (AMI). The aim of this study was to identify the predictive value of preprocedural HbA1c levels for cardiac events during mid-term follow-up period in diabetic patients complicated by AMI and underwent percutaneous coronary intervention (PCI).
Methods: A total of 2,324 AMI patients (65.0±11.4 years, 62.9% males) enrolled in a nationwide prospective Korea Working Group on Myocardial Infarction (KorMI) between Jan. 2008 and Aug. 2010 were included in the present study. The study population were diabetic patients complicated by AMI and underwent PCI and followed up during 12 months period. They were categorized into two groups by the level of preprocedural HbA1c (Group I: >6.5%, n=1,866; Group II: ≤6.5%, n=458). Major adverse cardiac events (MACE) included cardiac death, recurrent myocardial infarction, and re-PCI.
Results: Baseline clinical characteristics were similar between two groups, but group I were younger (63.3±11.4 vs. 67.6±11.0, p<0.001), smoker (35.7% vs. 30.1%, p=0.031) and had lesser history of hypertension (58.9% vs. 77.5%, p<0.001). Laboratory findings showed lower glomerular filtration rate (GFR) in group II (72.3±35.8mL/min vs. 64.5±34.3mL/min, p<0.001), and coronary angiographic findings showed no meaningful difference except more frequent involvement of left anterior descending artery in group I (48.4% vs. 41.9%, p = 0.026). Rates of MACEs during 12 months were similar between two groups (17.5% vs. 21.0%, p = 0.175). By multivariate analysis, old age, low GFR, high Killip class on admission were independently associated with MACEs, but HbA1c was not associated with poor patient outcome during mid-term follow-up period.
Conclusion: This study suggested that HbA1c is not a predictor of cardiac events in diabetic patients with AMI. These results suggest the absence of benefit of a strict hyperglycemia control in macrovascular complications, especially coronary artery disease such as myocardial infarction.
Keywords: glycosylated hemoglobin ▪ diabetes mellitus ▪ myocardial infarction ▪ prognosis
|
