# The Predictive Value of Hemoglobin Glycation Index and Clonal Hematopoiesis of Indeterminate Potential Among AMI Patients—A Prospective Registry Study

## TL;DR

This study shows that high hemoglobin glycation index combined with certain blood mutations increases mortality risk in heart attack patients.

## Contribution

The study introduces a novel composite indicator combining HGI and CHIP for cardiovascular risk stratification.

## Key findings

- High HGI levels significantly increase mortality risk in AMI patients with CHIP.
- TET2 and TET2/ASXL1 co-mutations show particularly high mortality risks in high HGI groups.
- HGI-CHIP synergy provides a refined method for cardiovascular risk assessment.

## Abstract

The objective of this research is to explore the combined effect of hemoglobin glycation index (HGI) and clonal hematopoiesis of indeterminate potential (CHIP) on all‐cause mortality among patients diagnosed with acute myocardial infarction (AMI).

The presence of CHIP in peripheral blood cells was detected using deep targeted sequencing. AMI patients were divided into groups based on the median value of HGI and assessed for the effect of CHIP on all‐cause mortality using multivariable Cox regression and Kaplan–Meier analysis.

Multivariable Cox regression indicated that among patients with HGI above the median value, CHIP carriers exhibited a significantly higher all‐cause mortality (any CHIP, adjusted HR: 2.06 95% CI: 1.10–3.85; p = 0.023), with analysis of specific mutations identifying particularly high risks for TET2 (adjusted HR: 3.72, 95% CI: 1.37–10.09; p = 0.010) and TET2/ASXL1 co‐mutations (adjusted HR: 2.61, 95% CI: 1.08–6.30; p = 0.033). Kaplan–Meier analysis in the high‐HGI group confirmed that carriers of any CHIP (p < 0.001) and common CHIP (p = 0.019) had a higher risk of mortality than noncarriers.

Our study reveals that HGI significantly modifies CHIP‐related all‐cause mortality risk, which provides a way for refined risk stratification in patients with AMI.

This study identifies a synergistic interaction between hemoglobin glycation index (HGI) and clonal hematopoiesis of indeterminate potential (CHIP). High HGI levels significantly amplify the mortality risk associated with CHIP in AMI patients, particularly for TET2 and ASXL1 mutations. This HGI‐CHIP composite indicator offers a novel insight for refined cardiovascular risk stratification.

The hemoglobin glycation index (HGI) serves as a composite marker integrating both metabolic and genetic factors. Recent studies indicate that the interplay between HGI and clonal hematopoiesis of indeterminate potential (CHIP), mediated through chronic inflammation, is a key driver of coronary atherosclerosis and poor prognosis. This synergy underscores the importance of assessing integrated metabolic‐genetic risk profiles for better cardiovascular risk stratification and targeted intervention.