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Hemoglobin A1c less than 6.5% on admission increases risk for in-hospital and 1-year mortality in patients with diabetes and chest pain

Hailpern, Susan M.a; Santel, Fabienneb; Mazurek, Jeremy A.b; Ramirez, Sheilab; Remick, Joshua D.b; Klein, Joshuab; Schubart, Ulrich K.b; Nordin, Charlesb

doi: 10.1097/XCE.0000000000000033
Original articles

Background: As the association between low hemoglobin A1c (HbA1c) and adverse clinical outcomes in patients with chest pain and myocardial infarction has not been extensively examined, a prospective cohort study was conducted to examine whether low HbA1c magnifies mortality risk.

Patients and methods: A total of 717 consecutive patients (284 with diabetes and 433 without known diabetes) admitted to a public hospital over a 6-month period with chest pain and troponin measurement were included. HbA1c was obtained upon admission. Mortality was confirmed by National Death Index search. Cox proportional hazards models were constructed for the sample stratified by diabetes status.

Results: The unadjusted incidence of mortality during hospitalization in patients with diabetes and HbA1c less than 6.5% (n=55) was 3.84 compared with those with HbA1c of 6.5% or more (n=229). In Cox proportional hazard models, patients with diabetes and HbA1c less than 6.5% had higher risk for in-hospital (hazard ratio 3.51, 95% confidence interval 1.25–9.83, P=0.02) and 1-year mortality (hazard ratio 3.50, 95% confidence interval 1.84–6.64, P<0.001) compared with those with HbA1c of 6.5% or more. No increase in risk was seen for those without diabetes and HbA1c less than 6.5%. Hypoglycemia (serum glucose<3.89 mmol/l) was more frequent in patients with diabetes and HbA1c less than 6.5% (44%) than those with HbA1c of 6.5% or more (22%) (P=0.001). Patients with hypoglycemia and diabetes had significantly higher rate of in-hospital mortality than those without [13.33% (10/75) vs. 2.87% (6/209), P<0.001].

Conclusion: Patients with diabetes admitted for chest pain with HbA1c less than 6.5% may be at increased risk for in-hospital and 1-year mortality. The mechanism for death may be mediated in part by hypoglycemia.

aDepartment of Epidemiology and Population Health

bDepartment of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA

A portion of these data was presented as a poster at the American Diabetes Association 69th Scientific Sessions; New Orleans, Louisiana; June 2009.

Correspondence to Charles Nordin, MD, Department of Medicine, Montefiore Medical Center, 111 E. 210th Street, Bronx, New York 10467, USA Tel: +1 718 920 5417; fax: +1 718 329 8452; e-mail: cnordin@montefiore.org

Received August 20, 2013

Accepted February 3, 2014

© 2014Wolters Kluwer Health Lippincott Williams Wilkins
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