Artículos de revistas
Glycosylated Hemoglobin Is Associated With Decreased Endothelial Function, High Inflammatory Response, And Adverse Clinical Outcome In Non-diabetic Stemi Patients.
Registro en:
Atherosclerosis. v. 243, n. 1, p. 124-130, 2015-Nov.
1879-1484
10.1016/j.atherosclerosis.2015.09.004
26385505
Autor
Moura, Filipe A
Figueiredo, Valeria N
Teles, Bruna S B S
Barbosa, Meyrianne A
Pereira, Lara R
Costa, Ana P R
Carvalho, Luiz Sergio F
Cintra, Riobaldo M R
Almeida, Osório L R
Quinaglia E Silva, Jose C
Nadruz Junior, Wilson
Sposito, Andrei C
,
Institución
Resumen
Chronic dysglycemia was recently identified as a predictor for adverse outcomes in patients with ST-elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention. Data for non-diabetic patients who underwent thrombolysis is scarce. In this context, we aimed to study the effect of HbA1c on cardiovascular outcome after STEMI. A prospective cohort of 326 non-diabetic STEMI individuals was used for the analyses. We measured plasma glucose, hemoglobin A1c [HbA1c], lipid profile, C-reactive protein (CRP), and nitrate/nitrite (NOx) upon admission and five days after STEMI (D5). Flow-mediated dilation (FMD) was performed 30 days after STEMI. During clinical follow-up, we assessed patients for incident diabetes (progression to HbA1c ≥ 6.5%) and major adverse cardiac events (MACE), defined as a composite of fatal and non-fatal MI, sudden cardiac death, and angina requiring hospitalization. Using ROC-curve analysis, a 5.8% HbA1c best predicted MACE with a sensitivity of 75% and specificity of 53% (AUC 0.673, p = 0.001). Patients were categorized as high HbA1c if ≥ 5.8% and low HbA1c if <5.8%. Compared with patients with low HbA1c, those with high HbA1c presented with 20% higher CRP-D5 (p = 0.009) and 19% higher ΔCRP (p = 0.01), a 32% decrease in ΔNOx (p < 0.001), and 33% lower FMD (p < 0.001). After a median follow-up of 1.9 (1.1-2.8) years, patients with high HbA1c had more incident diabetes (HR 2.3 95% CI 1.01-5.2; p = 0.048) and MACE (HR 3.32 95% CI 1.09-10.03; p = 0.03). Non-diabetic STEMI patients with high HbA1c present with decreased endothelial function and increased inflammatory response and long-term risk of MACE. 243 124-130