Changes over time in hemoglobin a1c (Hba_1c ) levels predict long-term survival following acute myocardial infarction among patients with diabetes mellitus

Frequent fluctuations of hemoglobin A1c (HbA_1C ) values predict patient outcomes. However, data regarding prognoses depending on the long-term changes in HbA_1C among patients after acute myocardial infarction (AMI) are scarce. We evaluated the prognostic significance of HbA_1C levels and changes among diabetic patients (n = 4066) after non-fatal AMI. All the results of HbA_1C tests up to the 10-year follow-up were obtained. The changes (∆) of HbA_1C were calculated in each patient. The time intervals of ∆HbA_1C values were classified as rapid (<one year) and slow (≥one year) changes. The outcome was all-cause mortality. The highest mortality rates of 53.8% and 35.5% were found in the HbA_1C < 5.5–7% and ∆HbA_1C = −2.5–(−2%) categories. A U-shaped association was observed between HbA_1C and mortality: adjOR = 1.887 and adjOR = 1.302 for HbA_1C < 5.5% and ≥8.0%, respectively, as compared with 5.5–6.5% (p < 0.001). Additionally, ∆HbA_1C was associated with the outcome (U-shaped): adjOR = 2.376 and adjOR = 1.340 for the groups of <−2.5% and ≥2.5% ∆HbA_1C, respectively, as compared to minimal ∆HbA_1C (±0.5%) (p < 0.001). A rapid increase in HbA_1C (but not decrease) was associated with a greater risk of mortality. HbA_1C values and their changes are significant prognostic markers for long-term mortality among AMI-DM patients. ∆HbA_1C and its timing, in addition to absolute HbA_1C values, should be monitored.