BACKGROUND HbA1c, the most commonly used indicator of chronic glucose metabolism, is closely associated with cardiovascular disease. However, the relationship between HbA1c and the mortality of acute coronary syndrome (ACS) patients has not been elucidated yet. Here, we aim to conduct a systematic review assessing the effect of HbA1c on in-hospital and short-term mortality in ACS patients. METHODS Relevant studies reported before July 2019 were retrieved from databases including PubMed, Embase, and Central. Pooled relative risks (RRs) and the corresponding 95% confidence interval (CI) were calculated to evaluate the predictive value of HbA1c for the in-hospital mortality and short-term mortality. RESULTS Data from 25 studies involving 304,253 ACS patients was included in systematic review. The pooled RR of in-hospital mortality was 1.246 (95% CI 1.113-1.396, p: 0.000, I2 = 48.6%, n = 14) after sensitivity analysis in studies reporting HbA1c as categorial valuable. The pooled RR was 1.042 (95% CI 0.904-1.202, p: 0.57, I2 = 82.7%, n = 4) in random-effects model for studies reporting it as continuous valuable. Subgroup analysis by diabetic status showed that elevated HbA1c is associated increased short-term mortality in ACS patients without diabetes mellitus (DM) history and without DM (RR: 2.31, 95% CI (1.81-2.94), p = 0.000, I2 = 0.0%, n = 5; RR: 2.56, 95% CI 1.38-4.74, p = 0.003, I2 = 0.0%, n = 2, respectively), which was not the case for patients with DM and patients from studies incorporating DM and non-DM individuals (RR: 1.16, 95% CI 0.79-1.69, p = 0.451, I2 = 31.9%, n = 3; RR: 1.10, 95% CI 0.51-2.38), p = 0.809, I2 = 47.4%, n = 4, respectively). CONCLUSIONS Higher HbA1c is a potential indicator for in-hospital death in ACS patients as well as a predictor for short-term mortality in ACS patients without known DM and without DM.

中文翻译：

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HbA1c对急性冠状动脉综合征患者的院内和短期死亡率的预后价值：系统评价和荟萃分析。

背景技术HbA1c是慢性葡萄糖代谢的最常用指标，与心血管疾病密切相关。但是，尚未阐明HbA1c与急性冠状动脉综合征（ACS）患者死亡率之间的关系。在这里，我们旨在进行系统的评估，以评估HbA1c对ACS患者的院内和短期死亡率的影响。方法从包括PubMed，Embase和Central在内的数据库中检索2019年7月之前报告的相关研究。计算合并的相对风险（RRs）和相应的95％置信区间（CI），以评估HbA1c对医院内死亡率和短期死亡率的预测价值。结果系统评价纳入了来自25项研究，涉及304253例ACS患者。住院死亡率的合并RR为1。在报告HbA1c具有一定价值的研究中进行敏感性分析后，结果为246（95％CI 1.113-1.396，p：0.000，I2 = 48.6％，n = 14）。在随机效应模型中，汇总的RR为1.042（95％CI 0.904-1.202，p：0.57，I2 = 82.7％，n = 4），报告为具有连续价值。按糖尿病状态进行的亚组分析显示，HbA1c升高与无糖尿病和无糖尿病的ACS患者的短期死亡率增加相关（RR：2.31，95％CI（1.81-2.94），p = 0.000，I2 = 0.0 ％，n = 5； RR：2.56，95％CI 1.38-4.74，p = 0.003，I2 = 0.0％，n = 2），对于DM患者以及纳入DM和非DM研究的患者并非如此-DM个人（RR：1.16，95％CI 0.79-1.69，p = 0.451，I2 = 31.9％，n = 3; RR：1.10，95％CI 0.51-2.38），p = 0.809，I2 = 47.4％，n = 4）。