Hemoglobin A1c levels and thrombus load in patients with type 2 diabetes mellitus and non-ST-segment elevation myocardial infarction

Abstract

Background: Patients with Type 2 Diabetes Mellitus (T2DM) facing non-ST-Segment Elevation Myocardial Infarction (NSTEMI) often exhibit a higher incidence of thrombotic events. Hemoglobin A1c (HbA1c) levels, indicative of glycemic control, might influence the thrombus burden in such cases. This study aimed to evaluate the relationship between HbA1c, and coronary thrombus burden expressed as thrombolysis in Myocardial Infarction (TIMI) thrombus grade, in NSTEMI patients. Methods: This cross-sectional comparative study was carried out on NSTEMI patients with T2DM who underwent early percutaneous coronary angiography. Patients were categorized into two groups based on HbA1c levels: Group I (optimal glycemic control, HbA1c ≤ 6.5%) and group II (suboptimal glycemic control, HbA1c > 6.5%). Detailed clinical, laboratory, and angiographic assessments were performed. The primary outcome measure was the TIMI thrombus grade. Results : Group II showed significantly higher weight compared to group I (p= 0.026). Group II exhibited higher fasting blood glucose (FBG) and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) levels (p< 0.001). Echocardiographic parameters demonstrated a significantly lower Mitral E in group II (p< 0.001). Angiographic parameters revealed a significant difference in the infarct-related artery (p= 0.026), with higher TIMI thrombus grade scores and Syntax scores in group II (p< 0.001). Revascularization selection varied significantly between groups (p= 0.038). Conclusion: Elevated HbA1c levels in NSTEMI patients with T2DM were associated with increased thrombus burden, as indicated by higher TIMI thrombus grades.