Hemoglobin A1c In Non-Diabetic NSTEMI Patients as a Predictor of Severity of Coronary Artery Disease

Abstract

Background: Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in diabetic and non-diabetic patients. The association between hemoglobin A1c (HbA1c) levels and coronary artery disease (CAD) severity in non-diabetic patients remains contentious. This study aimed to evaluate the association between HbA1c level and the severity of coronary artery disease in non-diabetic patients presenting with NSTEMI using SYNTAX score. Methods: This observational, dual-center, cross-sectional study included 74 non-diabetic patients with NSTEMI who underwent emergency coronary angiography. Patients were divided into two groups: those with HbA1c > 5% (Group 1) and those with HbA1c ≤ 5% (Group 2). The severity of CAD was assessed using the SYNTAX score, and logistic regression was performed to identify predictors of CAD severity Results: Group 1 had significantly higher HbA1c levels (5.8% vs. 4.6%, P < 0.001) and a higher incidence of multi-vessel disease compared to Group 2 (P = 0.045). Chronic total occlusion was also more prevalent in Group 1 (32.43% vs. 8.11%, P = 0.019). HbA1c levels were significantly correlated with higher SYNTAX scores (r = 0.353, P = 0.002), and logistic regression analysis identified HbA1c as an independent predictor of CAD severity. HbA1c had an area under the curve (AUC) of 0.742, with 82.35% sensitivity and 62.35% specificity at a cutoff of >4.8%. Conclusion: HbA1c levels > 4.8% are associated with increased CAD severity in non-diabetic NSTEMI patients, making HbA1c a potential independent predictor of coronary artery disease complexity.