Influence of admission glucose profile and hemoglobin A1c on complications of acute myocardial infarction in diabetic patients

S. Vujosevic, N. Radojevic, N. Belada

Clinical Centre of Montenegro, School of Medicine, University of Montenegro, Podgorica, Montenegro. com_nr@yahoo.com

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• Cardiology

BACKGROUND: Diabetic patients have a double higher short-term mortality rate after acute myocardial infarction (AMI) than non-diabetic ones. Admission glucose level has been already concerned as an independent risk factor for the long-term prognosis after myocardial infarction. The aim of this study is to evaluate the influence of admission glucose profile (AGP) and glycosylated hemoglobin (HbA1c) on complications of the AMI in patients with type 2 diabetes.

PATIENTS AND METHODS: The study was based on 76 diabetic patients hospitalized with first-ever AMI. Admission glucose profile was estimated as mean value of the first six blood glucose values, since HbA1c was measured from the blood sampled in the first morning after the admission to hospital. All post-infarction complications are divided into electrical and mechanical ones. ROC curves are used to analyze predictive values of admission glucose profile and HbA1c for developing post-infarction complications.

RESULTS: Admission glucose profile is a significant (p = 0.001) predictor of electrical complications with 12.25 mmol/L cut-off value (sensitivity 77.3%; specificity 64.5%), while it is not significant (p > 0.05) for mechanical complication (cut-off value 16.85 mmol/L; sensitivity 45.2%; specificity 77.8%). HbA1c is not enough good for the complication prediction (p > 0.05). Considering electrical and mechanical complications aggregately, AGP is even more significant (p = 0.000) with 14.85 mmol/L cut-off value (sensitivity 54.4%; specificity 94.7%), and HbA1c is significant, as well (p = 0.013, too with 9.07 % cut-off value (sensitivity 57.9%; specificity 78.8%).

CONCLUSIONS: Comparing the predictability between AGP and HbA1c, in our sample, the first one seems to be the better one. Admission glucose profile and HbA1c should be the obligatory laboratory tests performed at the time of hospital admission  after the heart attack.

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