The Relationship Between HbA1c and Contrast-Induced Nephropathy in Patients with Non-ST Elevation Myocardial Infarction and Non- Established Diabetes Mellitus

Abstract

Background: Diabetes Mellitus (DM) is an important cardiovascular risk factor and 50% of newly diagnosed diabetic patients have coronary artery disease. HbA1c levels in these patients have an effect on prognosis. Development of contrast agent-induced nephropathy (CIN) is common in patients who have undergone percutaneous coronary intervention (PCI) without ST elevation myocardial infarction (NSTEMI) and is associated with increased mortality and morbidity. In our study, the relationship between HbA1c and the development of CIN was investigated in NSTEMI patients who did not have a previous diagnosis of DM and receive treatment. Methods: In our study, 359 (189, 52.6% male) patients who were not diagnosed with DM and did not receive treatment were retrospectively analyzed for NSTEMI diagnosis. HbA1c and creatinine values before the procedure and post-procedure creatinine values were evaluated. CIN; It was defined as an increase of 25% or 0.5 mg / dl compared to the basal value in serum creatinine measured 48-72 hours after the procedure. Results: CIN was detected in 56 (15.6%) of all patients. Among the group with and without CIN; There was no difference between gender, amount of contrast material, pre-procedure eGFR, troponin and ejection fraction values. Only in the group with CIN, the patients were older and the number of hypertensive patients was significantly higher (Table 1). As a result of coronary angiography, medical follow-up was made for 46 (12.7%) patients, coronary stent in 271 (74.7%) and coronary bypass in 40 (11%) patients. In addition, in-hospital mortality was detected in 17 (4.7%) patients. HbA1c and fasting glucose levels were found significantly higher in the group developing CIN (6.1 ± 1.0 vs 5.5 ± 0.6, p <0.001, 133.8 mg/dl ± 65.9 vs 110.9 mg/dl ± 48.7, p: 0.002, respectively). But only the HbA1c value was determined to be an independent predictor in the logistic regression analysis of CIN (OR: 2.3, p <0.001, CI: 1.6-3.2). Conclusion: CIN was more common in NSTEMI patients with high HbA1c who were not diagnosed with DM and were not treated.In addition, HbA1c value was an independent predictor of CIN development.

Keywords

• HbA1c
• nephropathy
• myocardial infarction

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