HbA1c Predicts LV Dysfunction in STEMI Heart Attack

MedicalResearch.com Interview with:
Dr. Arnold Ng, MBBS, PhD
Department of Cardiology
Princess Alexandra Hospital
University of Queensland, Australia

Medical Research: What is the background for this study? What are the main findings?

Dr. Arnold: The WHO and American Diabetes Association currently recommends the use of HbA1c >=6.5% as a diagnostic criterion for diabetes. HbA1c is advantageous over fasting plasma glucose and glucose tolerance testing by avoiding the need for patient fasting and inconvenient patient preparation. In addition, patients who are acutely unwell (e.g. STEMI) may develop stress hyperglycemia, complicating the diagnosis of diabetes. It is currently unclear if HbA1c (indicative of overall glycemic control) or fasting plasma glucose predicts worse left ventricular function after acute STEMI.

The present study demonstrated that HbA1c identified approximately another 20% of previously undiagnosed patients as diabetic. Furthermore, the present study was first to demonstrate that HbA1c, not fasting plasma glucose, was independently associated with more impaired LV diastolic function and elevated filling pressures after STEMI.

Medical Research: What should clinicians and patients take away from your report?

Dr. Arnold: HbA1c is a useful and convenient tool to diagnose diabetes in acutely unwell patients. Furthermore, as HbA1c is a reflection of long term glycemic control, it is associated with worse acute LV dysfunction after STEMI. As coronary heart disease is a major cause of morbidity and mortality in diabetic patients, is important to maintain long term good glycemic control.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Arnold: The present study is first to demonstrate the acute prognostic value of HbA1c in STEMI patients. The value of routine HbA1c measurements in guiding therapy and predicting long term clinical outcomes in STEMI patients should be considered in future studies.

Citation:
Glycated Hemoglobin Versus Fasting Plasma Glucose as a Predictor of Left Ventricular Dysfunction After ST-Elevation Myocardial Infarction

Josh PJ. Tsai, MBBS, Jenny Tian, MBBS, William YS. Wang, MBBS, MM, PhD, Arnold CT. Ng, MBBS, PhD
Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Australia joint first author

Received: September 11, 2014; Received in revised form: October 25, 2014; Accepted: October 26, 2014; Published Online: October 30, 2014
Canadian Journal of Cardiology
http://dx.doi.org/10.1016/j.cjca.2014.10.029
Published Online: October 30, 2014