Glycosylated Hemoglobin and Outcomes in Diabetic Patients with Acute Myocardial Infarction after Successful Revascularization with Stent Placement: Findings from the Guthrie Health Off‐Label Stent (GHOST) Investigators

Singla, Anand; Orshaw, Pamela; Boura, Judy; Harjai, Kishore J.

doi:10.1111/j.1540-8183.2011.00715.x

Cited by 17 publications

(17 citation statements)

References 36 publications

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“…The findings of cohort studies (18)(19)(20)(21)(22) investigating the relation between HbA 1c level and new cardiovascular events in patients with and without type 2 diabetes after cardiac interventions for coronary artery disease are in line with our findings. In these studies (18,21,22).…”

Section: Discussionsupporting

confidence: 79%

The Relation Between HbA1c and Cardiovascular Events in Patients With Type 2 Diabetes With and Without Vascular Disease

et al. 2015

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OBJECTIVEPoor glycemic control is related to vascular events in patients with type 2 diabetes, but the presence of vascular disease might influence this relation. We evaluated the relation between glycemic control (HbA 1c level) and new cardiovascular events and mortality in patients with type 2 diabetes, with and without vascular disease. RESEARCH DESIGN AND METHODSIn a cohort of 1,687 patients with type 2 diabetes enrolled in the Second Manifestations of Arterial Disease (SMART) study, the continuous relation between HbA 1c and cardiovascular events (composite of myocardial infarction, stroke, and vascular mortality) and all-cause mortality was evaluated with Cox proportional hazard analyses stratified for the presence of vascular disease. RESULTSDuring a median follow-up time of 6.1 years (interquartile range 3.1-9.5 years), a new cardiovascular event developed in 293 patients and 340 patients died. In all patients, the hazard ratio (HR) of the relation between HbA 1c level and cardiovascular events was 1.06 (95% CI 0.97-1.17 CONCLUSIONSIn patients with type 2 diabetes, there is a modest, but not statistically significant, relation between HbA 1c level and cardiovascular events, and, as there was no statistically significant interaction, this relation was not different for patients with or without clinical manifestation of vascular disease.Strict glycemic control has been proposed as an important means to lower the risk of both microvascular and macrovascular complications of type 2 diabetes. A strong relation between glycemic control and microvascular complications (nephropathy, retinopathy, and neuropathy) and macrovascular complications is observed in patients

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Section: Discussionsupporting

confidence: 79%

The Relation Between HbA1c and Cardiovascular Events in Patients With Type 2 Diabetes With and Without Vascular Disease

et al. 2015

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“…Even though strict and multifactorial comprehensive management of atherosclerotic risk factors, such as obesity, smoking, lipid disorders and hypertension in secondary prevention of CV events in patients with diabetes is recommended [3], the prognostic implication of HbA1c level is still controversial and only a limited number of studies have addressed it with respect to CV mortality in patients with established coronary artery disease who underwent PCI. Moreover, most of previous studies binarized using 7.0% HbA1c and failed to show any significant differences in the incidences of adverse CV events between the groups [35][36][37][38][39][40], a finding which is consistent with that of this study. For a detailed evaluation of the prognostic impact of preprocedural HbA1c level, this study divided the participants into 5 groups with an almost equal distribution of patient numbers in each group, < 6.5%, 6.5-7.0%, 7.0-7.5%, 7.5-8.5% and ≥ 8.5%, allowing us to focus on the risk of lower HbA1c levels.…”

Section: Discussionsupporting

confidence: 91%

Increased risk of cardiovascular mortality by strict glycemic control (pre-procedural HbA1c < 6.5%) in Japanese medically-treated diabetic patients following percutaneous coronary intervention: a 10-year follow-up study

Funamizu

Iwata

Nishida

et al. 2020

Cardiovasc Diabetol

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Background: In the secondary prevention of cardiovascular (CV) disease in patients with diabetes, an optimal level of HbA1c, the most widely-used glycemic control indicator, for favorable clinical consequences still remains to be established. This study assessed the association between preprocedural HbA1c level and CV mortality in Japanese diabetic patients undergoing percutaneous coronary intervention (PCI). Methods: This is a retrospective observational study using a single-center prospective PCI database involving consecutive 4542 patients who underwent PCI between 2000 and 2016. Patients with any antidiabetic medication including insulin at PCI were included in the analysis (n = 1328). We divided the patients into 5 and 2 groups according to HbA1c level; HbA1c: < 6.5% (n = 267), 6.5-7.0% (n = 268), 7.0-7.5% (n = 262), 7.5-8.5% (n = 287) and ≥ 8.5% (n = 244), and 7.0% > and ≤ 7.0%, respectively. The primary outcome was CV mortality including sudden death. The median follow-up duration was 6.2 years. Results: In the follow-up period, CV and sudden death occurred in 81 and 23 patients, respectively. While unadjusted Kaplan-Meier analysis showed no difference in cumulative CV mortality rate between patients binarized by preprocedural HbA1c 7.0%, analysis of the 5 groups of HbA1c showed significantly higher cumulative CV death in patients with HbA1c < 6.5% compared with those with 7.0-7.5% (P = 0.042). Multivariate Cox hazard analysis revealed a U-shaped relationship between preprocedural HbA1c level and risk of CV death, and the lowest risk was in the HbA1c 7.0-7.5% group (Hazard ratio of HbA1c < 6.5% compared to 7.0-7.5%: 2.97, 95% confidence interval: 1.33-7.25, P = 0.007). Similarly, univariate analysis revealed the lowest risk of sudden death was in the HbA1c 7.0-7.5% group. Conclusion: The findings indicate an increased risk of CV mortality by strict glycemic control (HbA1c < 6.5%) in the secondary prevention of CV disease in Japanese patients with medically-treated diabetes.

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“…Irrespective whether they reflect SH as a marker or active player in worsening prognosis in AMI, the following mechanisms (some of them overlap importantly) are currently believed to contribute : increased bood concentration of free fatty acids (resulting from a relative insulin deficiency), which produce toxic effects on cardiomyocytes, increase myocardial oxygen need, and depress myocardial contractility 68 ; microvascular obstruction (due to plugging of leukocytes in the coronary capillaries and venules, giving raise to platelet-dependent thrombosis in the capillaries, etc.). Microvascular obstruction was considered the reasonable explanation for the findings on contrast-enhanced cardiovascular magnetic resonance (CMR) 69 .…”

Section: Putative Pathophysiologic Mechanisms Of Stress Hyperglycemiamentioning

confidence: 99%

“…Moreover, among diabetic patients, those with STEMI and glycemia > 8.5 mmol/L on admission had a poorer response to clopidogrel 76 . Additionally, improved glycemic control reduces platelet reactivity in DM patients after PCI 68 . From therapeutic point of view, it may be important that in ACS patients with hyperglycemia intensive glucose control results in a reduction of platelet reactivity only in the presence of elevated HbA1c levels 77 ; decreased nitric oxide bioavailability 78 ; possible increased risk for upper gastrointestinal bleeding 79 which may be due to stress ulcer, resulting from decreased gastric mucosal blood flow, increased gastric mucosal permeability with increased acid back-diffusion, and ischemia-reperfusion injury 80 .…”

Section: Putative Pathophysiologic Mechanisms Of Stress Hyperglycemiamentioning

confidence: 99%

Stress hyperglycemia in acute myocardial infarction

Koraćević

Vasiljevic

Veličković‐Radovanović

et al. 2014

VOJNOSANIT PREGL

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Glycosylated Hemoglobin and Outcomes in Diabetic Patients with Acute Myocardial Infarction after Successful Revascularization with Stent Placement: Findings from the Guthrie Health Off‐Label Stent (GHOST) Investigators

Abstract: Glycemic control, determined by HbA1c, does not seem to influence cardiovascular outcomes in diabetic patients with AMI after successful stent placement.

Cited by 17 publications

References 36 publications

The Relation Between HbA1c and Cardiovascular Events in Patients With Type 2 Diabetes With and Without Vascular Disease

The Relation Between HbA1c and Cardiovascular Events in Patients With Type 2 Diabetes With and Without Vascular Disease

Increased risk of cardiovascular mortality by strict glycemic control (pre-procedural HbA1c < 6.5%) in Japanese medically-treated diabetic patients following percutaneous coronary intervention: a 10-year follow-up study

Stress hyperglycemia in acute myocardial infarction

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