No association between hemoglobin A1c and in-hospital mortality in patients with diabetes and acute myocardial infarction

Kathryn A. Britton, Vikas Aggarwal, Anita Y. Chen, Karen P. Alexander, Ezra A Amsterdam, Elizabeth Fraulo, Paul Muntner, Laine Thomas, Darren K. McGuire, Stephen D. Wiviott, Matthew T. Roe, Ulrich K. Schubart, Caroline S. Fox

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Abstract

Background: Patients with diabetes have increased in-hospital mortality following acute myocardial infarction (AMI), with studies suggesting higher risk with both hypoglycemia and hyperglycemia. We assessed whether a J-shaped relation exists between hemoglobin A1c (A1C) in patients with diabetes and AMI. Methods: We assessed the associations between A1C and in-hospital mortality using data from a nationwide sample of AMI patients who had both prior diabetes and measurement of A1C (N = 15,337). Results: When evaluated continuously, we observed no evidence of a J-shaped relation between A1C and in-hospital mortality in multivariable analysis (test for linearity P = .89). Patients with lowest (<5.5%) and highest A1C (≥9.5%) had a crude mortality rate of 4.6% and 2.8%, respectively, compared with 3.8% among those in the referent A1C category (6.5% to <7%). In multivariable regression, we observed no association between low A1C (<5.5%, odds ratio 0.81, 95% CI 0.47-1.39) or high A1C (A1C ≥9.5, odds ratio 1.31, 95% CI 0.94-1.83) and mortality as compared with the referent group. These findings can only be generalized to the subset of patients with diabetes who had A1C assessed during their hospitalization; these patients tended to be healthier than those in whom A1C was not assessed. Conclusion: In this large contemporary cohort of patients with diabetes presenting with AMI, we did not observe a J-shaped association between A1C and mortality.

Original languageEnglish (US)
JournalAmerican Heart Journal
Volume161
Issue number4
DOIs
StatePublished - Apr 2011

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Hospital Mortality
Hemoglobins
Myocardial Infarction
Mortality
Odds Ratio
Hypoglycemia
Hyperglycemia
Hospitalization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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No association between hemoglobin A1c and in-hospital mortality in patients with diabetes and acute myocardial infarction. / Britton, Kathryn A.; Aggarwal, Vikas; Chen, Anita Y.; Alexander, Karen P.; Amsterdam, Ezra A; Fraulo, Elizabeth; Muntner, Paul; Thomas, Laine; McGuire, Darren K.; Wiviott, Stephen D.; Roe, Matthew T.; Schubart, Ulrich K.; Fox, Caroline S.

In: American Heart Journal, Vol. 161, No. 4, 04.2011.

Research output: Contribution to journalArticle

Britton, KA, Aggarwal, V, Chen, AY, Alexander, KP, Amsterdam, EA, Fraulo, E, Muntner, P, Thomas, L, McGuire, DK, Wiviott, SD, Roe, MT, Schubart, UK & Fox, CS 2011, 'No association between hemoglobin A1c and in-hospital mortality in patients with diabetes and acute myocardial infarction', American Heart Journal, vol. 161, no. 4. https://doi.org/10.1016/j.ahj.2010.12.004
Britton, Kathryn A. ; Aggarwal, Vikas ; Chen, Anita Y. ; Alexander, Karen P. ; Amsterdam, Ezra A ; Fraulo, Elizabeth ; Muntner, Paul ; Thomas, Laine ; McGuire, Darren K. ; Wiviott, Stephen D. ; Roe, Matthew T. ; Schubart, Ulrich K. ; Fox, Caroline S. / No association between hemoglobin A1c and in-hospital mortality in patients with diabetes and acute myocardial infarction. In: American Heart Journal. 2011 ; Vol. 161, No. 4.
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T1 - No association between hemoglobin A1c and in-hospital mortality in patients with diabetes and acute myocardial infarction

AU - Britton, Kathryn A.

AU - Aggarwal, Vikas

AU - Chen, Anita Y.

AU - Alexander, Karen P.

AU - Amsterdam, Ezra A

AU - Fraulo, Elizabeth

AU - Muntner, Paul

AU - Thomas, Laine

AU - McGuire, Darren K.

AU - Wiviott, Stephen D.

AU - Roe, Matthew T.

AU - Schubart, Ulrich K.

AU - Fox, Caroline S.

PY - 2011/4

Y1 - 2011/4

N2 - Background: Patients with diabetes have increased in-hospital mortality following acute myocardial infarction (AMI), with studies suggesting higher risk with both hypoglycemia and hyperglycemia. We assessed whether a J-shaped relation exists between hemoglobin A1c (A1C) in patients with diabetes and AMI. Methods: We assessed the associations between A1C and in-hospital mortality using data from a nationwide sample of AMI patients who had both prior diabetes and measurement of A1C (N = 15,337). Results: When evaluated continuously, we observed no evidence of a J-shaped relation between A1C and in-hospital mortality in multivariable analysis (test for linearity P = .89). Patients with lowest (<5.5%) and highest A1C (≥9.5%) had a crude mortality rate of 4.6% and 2.8%, respectively, compared with 3.8% among those in the referent A1C category (6.5% to <7%). In multivariable regression, we observed no association between low A1C (<5.5%, odds ratio 0.81, 95% CI 0.47-1.39) or high A1C (A1C ≥9.5, odds ratio 1.31, 95% CI 0.94-1.83) and mortality as compared with the referent group. These findings can only be generalized to the subset of patients with diabetes who had A1C assessed during their hospitalization; these patients tended to be healthier than those in whom A1C was not assessed. Conclusion: In this large contemporary cohort of patients with diabetes presenting with AMI, we did not observe a J-shaped association between A1C and mortality.

AB - Background: Patients with diabetes have increased in-hospital mortality following acute myocardial infarction (AMI), with studies suggesting higher risk with both hypoglycemia and hyperglycemia. We assessed whether a J-shaped relation exists between hemoglobin A1c (A1C) in patients with diabetes and AMI. Methods: We assessed the associations between A1C and in-hospital mortality using data from a nationwide sample of AMI patients who had both prior diabetes and measurement of A1C (N = 15,337). Results: When evaluated continuously, we observed no evidence of a J-shaped relation between A1C and in-hospital mortality in multivariable analysis (test for linearity P = .89). Patients with lowest (<5.5%) and highest A1C (≥9.5%) had a crude mortality rate of 4.6% and 2.8%, respectively, compared with 3.8% among those in the referent A1C category (6.5% to <7%). In multivariable regression, we observed no association between low A1C (<5.5%, odds ratio 0.81, 95% CI 0.47-1.39) or high A1C (A1C ≥9.5, odds ratio 1.31, 95% CI 0.94-1.83) and mortality as compared with the referent group. These findings can only be generalized to the subset of patients with diabetes who had A1C assessed during their hospitalization; these patients tended to be healthier than those in whom A1C was not assessed. Conclusion: In this large contemporary cohort of patients with diabetes presenting with AMI, we did not observe a J-shaped association between A1C and mortality.

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