The Impact of Admission Glycated Hemoglobin Level on the in-Hospital Outcome in Patients with Acute Myocardial Infarction

Abstract

SUMMARY T he life expectancy of both men and women diagnosed as having diabetes at age 40 is reduced by eight years relative to people without diabetes (Roper et al., 2001). The prevention of macrovascular complications of diabetes requires a multifactorial approach addressing all major modifiable risk factors, including blood pressure and blood lipids (Gæde et al., 2008). The aim of the study was to study the impact of blood sugar control on the in-hospital outcome in patients with diabetes type II surviving their first acute myocardial infarction. It included 100 adult patients with type II DM who were admitted to the CCU of Ain Shams University Hospitals with first time Acute ST-elevation Myocardial infarction. All patients were subjected to the following full History, including the onset of DM and complications of diabetes. General and local cardiac examination was done and Fundus examination was performed for the detection of Retinopathy. All patients underwent Transthoracic Echocardiography for assessment of EF and WMSI and resting TC99m MIBI to identify site and size of the infarction. HbA1c and microalbuminurea values were estimated for every patient. They were followed up for in hospital morbidity, mortality and occurrence of complications. In the present study infarction size was significantly larger in patients with poor blood sugar control as compared to those with good control (mean value 42.5 ± 14.18% vs 20.75 ± 14.94%). The prevalence of MACE was 36% with no mortality. Diabetic retinopathy as detected by funduscopy, poor blood sugar control as detected by higher HbA1c, higher microalbuminurea, lower EF and larger defect size were the factors associated with increased MACE.