The association between HbA1c/C-peptide levels and short-term mortality in patients diagnosed with myocardial infarction

Abstract

Introduction: In this study, we aimed to investigate the effect of HbA1C/C-peptide ratio on short-term mortality (this period is defined as 30 days after diagnosis) in the patients with myocardial infarction. Materials & Methods: Around 3245 patients who were admitted due to ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction underwent primary percutaneous coronary intervention between October 2020 and 2024 were included in this study. Results: In the receiver operating characteristic analysis, the predictive power of the HCR score for mortality in ST-elevation myocardial infarction patients was determined to be 83% sensitivity and 81% specificity. In non-ST-elevation myocardial infarction, this was determined to be 78% sensitivity and 75% specificity. Conclusion: The HbA1C/C-peptide ratio score can predict poor clinical outcomes early, reducing mortality and morbidity in patients with myocardial infarction.

Article highlights

Background

• Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality worldwide despite advancements in medical and interventional procedures.

• Type 2 diabetes mellitus is a significant risk factor for ASCVD, prompting guidelines for managing cardiovascular disease in diabetic patients by the European Society of Cardiology in 2023.

• Hemoglobin A1c (HbA1c) is a crucial biomarker for diabetes diagnosis and C-peptide indicates endogenous insulin production.

Method

• The study included 3245 patients with an acute myocardial infarction undergoing primary percutaneous coronary intervention between October 2020 and October 2024.

• Patients were divided into STEMI and NSTEMI groups and HbA1c/C-peptide ratio (HCR) evaluated for all patients.

Results

• STEMI patients had significantly higher troponin and HbA1c levels but lower C-peptide levels compared with NSTEMI patients.

• The HCR was significantly higher in the STEMI group and predicting short-term mortality.

• Multivariate logistic regression identified HCR, diabetes mellitus, creatinine, troponin, body mass index, smoking, HbA1c and C-peptide as independent predictors of myocardial infarction.

Discussion

• Acute coronary syndromes result from restricted coronary blood flow and thrombus formation.

• Diabetes enhances thrombotic events due to the prothrombogenic effect of HbA1c and antithrombogenic properties of C-peptide.

• HCR combines the predictive values of HbA1c and C-peptide into a single fraction, providing a better prediction of thrombus burden and short-term mortality.

• The HCR score is directly proportional to high HbA1c and low C-peptide, suggesting it as a more effective predictor than HbA1c and C-peptide alone.

Conclusion

• The HCR is a novel, independent predictor of short-term mortality in patients with myocardial infarction.

• The HCR offers better predictive value for thrombus formation and short-term mortality than HbA1c or C-peptide alone.

• Incorporating HCR into the diagnostic process can improve the stratification and management of high risk in patients with myocardial infarction.

Keywords: :

• HbA1C/C-peptide ratio
• myocardial infarction
• short-Term Mortality

Financial disclosure

The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. PROJECT NO:23-KAEK-123. PROJECT DATE:25.05.2023. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.