Impact of Admission Glycosylated Hemoglobin (HbAlc) on Patients with Acute STEMI Undergoing Primary PCI

Background: HbAlc reflects longer-term glycemic control and having the edge to be less influenced by acute stress. Several studies demonstrated the prognostic role of HbAlc in elective PCIand acute MI patients treated with thrombolytic therapy. However, the impact of HbAlc level on prognosis in STEMI patients successfully treated with primary PCI has not been explicitly examined. Purpose: We assessed the prognostic role of HbAlc for in hospital and intermediate term (6 months) mortality & morbidity in STEMI patients managed with primary PCI. Methods: Through a prospective study conducted on 50 patientswere subdivided according to their admission HbAlc level into two groups. Group 1 with admission glycosylated hemoglobin level 7mg/d1 (25 patients), and group 2 with admission glycosylated hemoglobin >7mg/dl (25 patients). Results: With the exception of diabetes, all other demographic data were similar in both groups. Post procedural TIMI flow and myocardial blush grade were similar in both groups. No significant statistical difference as regard lesion type, culprit vessel, stent length or stent diameter. Neither in hospital MACE (re-infarction and target vessel revascularization) nor mortality showed significant statistical difference between both groups. All the intermediate term MACE (unstable angina & revascularization) and mortality was statistically insignificant except for heart failure which was statistically significant between both groups (p=0.008). Multivariate logistic regression analysis showed that myocardial blush grade followed by TIMI flow and fmally DM are the predictor of heart failure. On the other hand statistical analysis showed that a cutoff point of 7.1mg/d1 could be considered a threshold above which complication start to occur with moderate sensitivity and specificity. Conclusions: Although HbAlc cannot predict procedural results, in hospital mortality or morbidity, it can predict intermediate term morbidity in the form of heart failure which may be a particular cause of longer term mortality in those patients. HbA1C cutoff point of 7.1mg/d1 could be considered a threshold above which complication start to occurwith moderate sensitivity and specificity. Correspondence to: Dr. Ahmed M. Abdel-Salam, The Department of Cardiology, Faculty of Medicine, Ain Shams University