The independent prognosting value of HbA1c leves effects on early mortality in patients with acute coronary syndrome (ACS)

Aim: HbA1c is a mark shows chronic glucose dysregulation. We investigated the independent prognosting value of HbA1c leves in predicting early mortality in patients with acute coronary syndrome (ACS).
Method: This was a single center,retrospective study carried up at Vakif Gureba Training and Research Hospital. Five hundred patients who admitted to coronary intensive unit(CIU); because of ACSwere evaluated. We excluded patients who have chronic diesease which may affect the mortality (such as chronic heart failure, chronic renal failure, arrhythmia, Diabetes Mellitus, and cirrhosis). Their first CIU labratory measurements were analyzed and compared. Their first month polyclinic control documents searched to learn their health status. When we determined that the patient did not come to control we contacted his/her home number and taked information about patient’s health.
Results: In this retrospective study, 500 patients who admitted to coronary intensive unit(CIU) because of ACS were evaluated. The highest HbA 1c value was 12,58% and the lowest finded value was 4,18% (avarage was 6,71%). The patient who didnt come to one month polyclinic control after ACS; phoned from homephone to learn about his/her health. Twenty three of them died (13 were male and 10 were female). When died and alive patients compared;the 1st admission blood glucose and BUN levels of patients that died were higher than those not died after 1 month of follow-up (189±119 versus 135±80mg/dL, p=0,041 and 68,91±30,72 versus 43,79±24,75 mg/dl, p< 0,001, respectively). But there was no significant difference in HbA1c levels between these two groups (6,6±1,6 versus 6,71±2,07%, p= 0,917).
Conclucion: In our study on acute coronary syndrome, admission blood glucose,BUN, creatinin, and HbA1c values were compared in patients that died and still alive after 1 month of CIU admission. There was no correlation between admission HbA1c values and early mortality in these patients. On the other hand, admission blood glucose and BUN values were correlated with early mortality of these patients.

HbA1c’nin akut koroner sendrom (AKS) geçirmiþ hastalarda erken mortaliteye etkisi

Amaç: Glukoz regülasyonunu gösteren HbA1c’nin AKS geçirmiþ hastalarda erken mortaliteye etkisini araþtýrmaktýr.
Metod: 2006 yýlýnda alýnan etik kurul onayýndan sonra Vakýf Gureba Hastanesi koroner yoðun bakým ünitesine (KYBÜ) akut koroner sendrom tanýsýyla yatan 500 hasta dosya tarama yontemiyle deðerlendirmeye alýndý. Kronik böbrek yetmezliði, kronik kalp yetmezliði, diyabet, siroz, aritmi gibi erken dönem mortaliteyi etkileyecek hastalýklarý olan hastalar çalýþmaya alýnmadý. Tüm hastalarýn yoðun bakýma yatýrýldýðý andaki biyokimya tahlilleri ile KYBÜ ünitesinde kaldýðý süredeki ölümleri ve taburcu olduktan bir ay sonraki poliklinik takipleri incelendi. Poliklinik kontrolüne gelemeyen hastalar ise kontrol ve durum sorgulamasý amacýyla telefonla arandý.
Bulgular: HbA1c düzeyleri en düþük %4,18 en yükseði %12,58 olmak üzere ortalama 6,71 idi. Hastalarýn KYBÜ takibinden sonra 1. ayda poliklinik kontrollerinin incelenmesi ve gelmeyen hastalarýn telefonla aranmasý sonucu 23 hastanýn AKS sonrasýnda ilk 1 ay içersinde kardiyak nedenlerle kaybedildiði ve bu hastalarýn 13 ‘ünün erkek 10’unun kadýn olduðu saptandý. Ölen hastalarýn tüm deðerleri ile hayatta kalan hastalarýn tüm deðerleri karþýlaþtýrýldýðýnda; ölen hastalarýn ilk geliþteki kan þekeri ve üre deðerlerinin hayatta kalanlara oranla yüksek olduðu tespit edildi (kan þekeri için 135±80, 189±119 mg/dl; p=0,041 üre için 43,79±24,75; 68,91±30,72 mg/dl, p< 0,001). Oysa HbA1c leri karþýlaþtýrýldýðýnda arada anlamlý fark olmadýðý tespit edildi (6,71±2,07; 6,6±1,6 p= 0,917).
Sonuç: Akut koroner sendrom geçiren hastalarda HbA1c deðeri erken mortaliteyi belirlemede etkin bir parametre deðildir. Ancak baþlangýçta ölçülen kan þekeri ve üre deðeri erken mortaliteyi belirlemede etkili gibi görünmektedir.