Impact of Glycaemic Control on STEMI Outcomes after Primary PCI

Abstract

Objective: To evaluate the impact of glycaemic control, measured by HbA1c levels, on in-hospital outcomes in STEMI patients undergoing primary PCI, particularly within the South Asian population, where diabetes is a prevalent risk factor and management strategies remain suboptimal. Methodology: This retrospective study was conducted at Hayatabad Medical Complex, Peshawar, from January 2023 to December 2023. A total of 300 STEMI patients were enrolled, equally divided into two groups: Diabetic (n=150) and Non-Diabetic (n=150). Clinical parameters, in-hospital outcomes, and major adverse cardiovascular events (MACE) were assessed. The one-year period allowed for a focused dataset, reflecting current trends in glycaemic management at the institution. STEMI diagnosis was confirmed via ECG changes and elevated cardiac biomarkers. Statistical analyses were performed using SPSS version 25, with significance set at p < 0.05. Results: The mean HbA1c levels were significantly higher in the Diabetic group (8.0 ± 0.87%) compared to Non-Diabetics (5.14 ± 0.61%) (p < 0.001). In-hospital mortality was significantly higher in Diabetic patients (10%) compared to Non-Diabetics (4%) (p = 0.02). No significant differences were observed in reinfarction (15% vs. 10%, p = 0.23), heart failure (5% vs. 3%, p = 0.34), stroke (2% vs. 2%, p = 1.0), multivessel disease (12% vs. 10%, p = 0.53), and arrhythmia (7% vs. 6%, p = 0.35). Logistic regression identified diabetes as an independent predictor of mortality (OR: 2.5, 95% CI: 1.1 – 5.7, p = 0.02). Conclusion: Poor glycaemic control is associated with increased mortality in STEMI patients undergoing PCI. Routine HbA1c assessment may improve risk stratification and guide management strategies. Optimal glycaemic control is essential for improving survival and reducing complications. Future research should focus on long-term outcomes and effective diabetes management strategies in PCI patients.