J-curve relationship between long term glycemic control and mortality in diabetic patients with acute myocardial infarction undergoing percutaneous coronary intervention

• Published in: Cardiovascular diabetology Vol. 20; no. 1; p. 234
• Main Authors: Choi, Ik Jun, Choo, Eun Ho, Kim, Hwa Jung, Lim, Sungmin, Moon, Donggyu, Lee, Kwan Yong, Hwang, Byung-Hee, Kim, Chan Joon, Park, Mahn-Won, Lee, Jong-Min, Park, Chul Soo, Kim, Hee-Yeol, Yoo, Ki-Dong, Jeon, Doo Soo, Chung, Wook Sung, Kim, Min Chul, Jeong, Myung Ho, Ahn, Youngkeun, Chang, Kiyuk
• Format: Journal Article
• Language: English
• Published: England BioMed Central 15-12-2021; BMC
• Subjects: Age; Age Factors; Aged; Angioplasty; Biomarkers - blood; Blood Glucose - drug effects; Blood Glucose - metabolism; Blood pressure; Cardiovascular disease; Cause of Death; Clinical outcomes; Diabetes; Diabetes mellitus; Diabetes Mellitus - blood; Diabetes Mellitus - diagnosis; Diabetes Mellitus - drug therapy; Diabetes Mellitus - mortality; Ejection fraction; Electrocardiography; Female; Glucose; Glycated hemoglobin A; Glycated Hemoglobin A - metabolism; Glycemic Control - adverse effects; Glycemic Control - mortality; Heart attacks; Humans; Hypertension; Hypoglycemia; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Investigations; Kidney diseases; Male; Middle Aged; Mortality; Myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Original Investigation; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - mortality; Population; Registries; Republic of Korea - epidemiology; Risk Assessment; Risk Factors; Stroke; Time Factors; Treatment Outcome; Republic of Korea; Myocardial infarction; Glycated hemoglobin A; Hypoglycemia; Diabetes mellitus; Mortality
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-021-01428-x

Intensive glycemic control is generally recommended for diabetic patients to reduce complications. However, the role of glycemic control in the mortality in diabetic patients with acute myocardial infarction (AMI) remained unclear.
We selected diabetic patients who measured HbA1c more than 3 times after AMI among 10,719 patients enrolled in the multicenter AMI registry. Patients (n = 1384) were categorized into five groups: according to mean HbA1c level: ≤ 6.5%, > 6.5 to ≤ 7.0%, > 7.0 to ≤ 7.5%, > 7.5 to ≤ 8.0% and > 8.0%. The primary endpoint was all-cause mortality.
During a median follow-up of 6.2 years, the patients with a mean HbA1c of 6.5 to 7.0% had the lowest all-cause mortality. Compared to patients with mean HbA1c of 6.5 to 7.0%, the risk of all-cause mortality increased in subjects with mean HbA1c ≤ 6.5% (adjusted hazard ratio [HR] 2.00, 95% confidence interval [CI] 1.02-3.95) and in those with mean HbA1c > 8.0% (adjusted HR 3.35, 95% CI 1.78-6.29). In the subgroup analysis by age, the J-curve relationship between mean HbA1c and all-cause mortality was accentuated in elderly patients (age ≥ 65 years), while there was no difference in all-cause mortality across the HbA1c groups in younger patients (age < 65 years).
The less strict glycemic control in diabetic patients with AMI would be optimal for preventing mortality, especially in elderly patients.