Muthiah Vaduganathan, MD, MPH: Identifying Dysglycemia in STEMI Patients


An analysis from AHA 2020 suggests an HbA1c screening protocol doubled the proportion of patients with known dysglycemia when treating patients with ST-elevation myocardial infarction.

A prospective study of patients from Northern India is highlighting missed opportunities for screening and management of dysglycemia in patients admitted to the hospital with ST-elevation myocardial infarction (STEMI).

An analysis of more than 3500 patients presenting to a pair of medical centers in New Delhi, results suggest a protocolized HbA1c screening approach doubled the proportion of patients with known dysglycemia.

For the purpose of the study, which was presented at the American Heart Association (AHA) Scientific Sessions 2020, investigators instituted an HbA1c collection protocol at the 2 medical centers in hopes of identifying the prevalence of dysglycemia among the patients with STEMI. Using a period from January-November 2019, 3635 patients with STEMI were identified for inclusion.

The median age of the study cohort was 55 (45-62) years, 16% were women, 54% had a BMI of 30 kg/m2 or greater, and 24% (n=855) had a prior history of diabetes. Among those with known diabetes, the median HbA1c was 7.4% (6.4-8.2%). Analysis of treatment history indicated only 1 (0.1%) patient was being treated with an SGLT2 inhibitor and 21 (2%) had received treatment with GLP-1 receptor agonists.

Among the 2668 patients without known diabetes, the median HbA1c was 5.5% (5.1-5.9%). This group included 737 patients with newly detected prediabetes and 339 with newly diagnosed diabetes mellitus. Results of the investigators’ analyses suggested those with known or newly detected prediabetes and diabetes mellitus had greater rates of post-MI left ventricular dysfunction than euglycemic patients (P <.0001). Results also indicated similar trends in regard to in-hospital and 30-day mortality when comparing the patient groups (P <.0001 for both).

For more on this study and what implications it may have for clinical practice in the US, check out this video with the study’s lead investigator Muthiah Vaduganathan, MD, MPH, a cardiologist at Brigham and Women’s Hospital.

This study, “Missed Opportunities for Screening and Management of Dysglycemia After Myocardial Infarction: The Prospective NORIN STEMI Registry,” was presented at AHA 2020.

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