Impact of HbA1c on Outcomes of Acute Coronary Syndrome in Non-Diabetic Patients

Background : Elevated glucose levels have been previously shown to be associated with adverse outcomes in patients of acute coronary syndrome. However, admission glucose levels are affected by various factors like meals, circadian cycle and also the stress response. HbA1c is a better marker of long- term glucose status. The value of HbA1c as a predictor of prognosis in acute coronary syndrome has not been extensively studied. Objective : To study the relationship between admission HbA1c levels and short-term outcome in non-diabetic patients admitted with acute coronary syndrome. Material and Methods : This open-label, hospital based, cohort study was conducted on 200 patients without previously known diabetes admitted with acute coronary syndrome. A detailed history and clinical examination were carried out. Admission plasma glucose, fasting glucose and HbA1c levels were recorded. Those presenting with fasting plasma glucose of >126 mg% or HbA1c >6.5% were labeled as “Undiagnosed Diabetic Patients”. Outcome was measured mainly by assessing the left ventricular systolic function. Data were analysed using chi square test, student t-test, ANOVA and partial correlation regression, wherever applicable. Results : Mean age of patients was 56.38 years. Average BMI was 25.1±3.5 kg/m2. Mean HbA1c was 6.3±1.5%. 79 (39.5%) patients had HbA1c between 6 and 6.5. There was a linear correlation between ejection fraction and HbA1c (p value =0.019). Conclusion : HbA1c is a strong predictor of left ventricular dysfunction in non-diabetic patients presenting with acute coronary syndrome, therefore, measurement of HbA1c levels may improve risk assessment in patients presenting with acute coronary syndrome.