In population-based studies, including diabetic and 110ndiabeticcohorts, glycated hemoglobin Alc (HbA 1c) has been reported as an independent predictor of all cause and cardiovascular disease mortality. Data on the prognostic role of HbA Ic in patients with acute myocardial infarction (MI) arc not univocal since they stem from studies which mainly differ in patients' selection criteria, therapy (thrombolysis vs mechanical revascularization) and number consistency. The present review is focused on available evidence on the prognostic significance of HbAlc measured in the acute phase in patients with ST-elevation myocardial infarction (STEM!) submitted to primary percutaneous coronary intervention (PCI). We furthermore highlighted the role ofHbAlc as a screening tool for glucose intolerance inpatients with STEM!. According to available evidence, in contemporary cohorts of STEMI patients submitted to mechanical revascularization, HbA I c does not seem to be associated with short and long term mortality rates. However, HbA Ic may represent a screening tool for glucose intolerance from the early phase on in STEMI patients. On a pragmatic ground, an HbA I c test has several advantages over fasting plasma glucose or an oral glucose tolerance test in an acute setting. The test can be performed in the non-fasting state and reflects average glucose concentration over the preceding2-3 mo. We therefore proposed an algorithm based on pragmatic grounds which could be applied in STEM! patients without known diabetes in order to detect glucose intolerance abnormalities from the early phase. The main advantage of this algorithm is that it may help in tailoring the follow-up program, by helping in identi fying patients at risk for the development of glucose intolerance after MI. Further validation of this algorithm in prospective studies may be required in the contemporary STEM( population to resolve some of these uncertainties around HbA I c screening cutoff points. Metbods: 100 patients from the attendants ofthe cardiology department who were admitted with STEMI without known history of diabetes and HBA IC was donc in first hour of admission. patients were classified in three groups according to HBA IC < 5.7 & 5.7 to 6.4 & > 6.4. Results: Mortality was statistical.ly significant in patient group with HBA I C above 6.4 with p value (0.006). Mean HBAIC was highly significant in patients with mortality than patients without mortality patients by mean HBA IC in mortality group 7.05 with SD (0.07) while in patient group without mortality mean
HBAIC was 6.48 % with SD (0.47) with P value (0.006). Conclusion: Higher HbAlc level should be considered Jor risk ?tratificati€ln of patients presented by acute STEM! Who are-amenable to primary PCI. -So aggressive management ofthose high risk patients is mandlitory. ..
, The present study shows thal admission higher HbA Ic level in patients presented by acute STEM! is associated with more severe CAD. lower ST-segment resolution. lower rate of complete revascularization TIM( 3 and higher incidence ofmortality. . • [Ahmed S. Mohamed, Elsayed Abd. Mohamed, Ali I. Attia, and Mohamed M. Ali. Clinical significance of glycated haemoglobin in Egyptian patients presented in acute phase of ST elevation myocardial infarction. IV Y Sci J 2017; 10(7):35-44]. rSSN 1554-0200 (print); ISSN 2375-723X (online). http://Vvw.sciencc.ill!h.nctlD..9:YYork.
6. doi: 1O.7537!m1l1'snys IJlQ117.06. |
