Glycosylated Hemoglobin Is a Predictor of Major Adverse Cardiac Events after Drug-Eluting Stent Implantation in Patients with Diabetes Mellitus

Objectives: Previous studies investigating the prognostic value of HbA_1c in patients undergoing coronary angiography reported a mixed pattern of results. Therefore, we aimed to better define the prognostic power of HbA_1c among coronary catheterized patients. Methods: Patients undergoing coronary angiography (n = 3,749) were divided into four groups according to HbA_1c levels (<5, 5-6, 6-7 and >7%). Cox regression models assessed long-term mortality after adjusting for multiple covariates. Results: Baseline clinical profiles differed in HbA_1c groups, with a higher prevalence of comorbidities in the groups with higher HbA_1c levels. Median follow-up was 1,745 days (interquartile range 1,007-2,171). A J-shaped association curve was observed between HbA_1c levels and all-cause mortality rates, with patients in the lowest and highest HbA_1c groups suffering from significantly higher mortality rates compared to in-between groups (hazard ratio 1.9, 95% CI 1.32-2.74, p = 0.001, and hazard ratio 1.58, 95% CI 1.29-1.95, p < 0.001, for the lowest and highest HbA_1c groups, respectively). This association persisted after adjustment for anemia, nutritional status, renal function, cardiovascular risk factors and inflammatory biomarkers. Conclusions: HbA_1c levels <5 or >7% are predictors of all-cause mortality in patients undergoing coronary angiography.

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“…As discussed before, previous trials designed to answer this question were diverse and reached different conclusions [8,9,10,11]. …”

Section: Discussionmentioning

confidence: 99%

“…Consequently, a mixed pattern of results was shown regarding the ability of HbA 1c to predict outcomes in this patient population [8,9,10,11]. …”

Section: Introductionmentioning

confidence: 99%

HbA1c Levels and Long-Term Mortality in Patients Undergoing Coronary Angiography

et al. 2016

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“…However, recent studies have shown HbA1c to be associated with an increased risk of MACE after PCI in diabetic patients. 60,61 Further study is required to determine whether HbA1c is an independent predictor of progression of nontarget lesions in diabetic patients.…”

Section: Predictors Of Progression Of Clinical Nontarget Lesions Requmentioning

confidence: 99%

Percutaneous Coronary Intervention Rates and Associated Independent Predictors for Progression of Nontarget Lesions in Patients With Diabetes Mellitus After Drug-Eluting Stent Implantation

et al. 2015

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Little is known about clinically driven percutaneous coronary intervention (PCI) rates and predictors for progression of nontarget lesions in diabetic patients who have undergone drug-eluting stent (DES) implantation. We retrospectively analyzed the clinical and angiographic data of 2187 diabetic patients undergoing DES implantation. The cumulative rate of nontarget lesion PCI was 6.3% at 1 year, 14.3% at 2 years, and 19.8% at 3 years. The independent predictors of need for clinically driven PCI in patients with diabetes mellitus after DES implantation included obesity (odds ratio [OR] 2.303, 95% confidence interval [CI] 1.657-3.199, P < .001), low levels of high-density lipoprotein cholesterol (OR 1.412, 95% CI 1.114-1.789, P ¼ .004), statin use (OR 0.669, 95% CI 0.454-0.986, P ¼ .042), insulin use (OR 1.310, 95% CI 1.030-1.665, P ¼ .027), and Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score (OR 1.061, 95% CI 1.045-1.077, P < .001) at baseline PCI. These findings may facilitate prediction of the risk of repeat revascularization and improve repeat revascularization rates in diabetic patients after DES implantation.

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“…Interaction between AGEs and receptors for AGE participates in the development and acceleration of diabetic vasculopathy [2]. Glycated hemoglobin A 1c (HbA 1c ) has been widely recognized as a marker of glycemic control [3] and was used to estimate the degree of coronary artery disease (CAD) and the risk of major adverse cardiac events (MACE) after successful implantation of drug-eluting stents in patients with type 2 diabetes mellitus (T2DM) [4,5]. Glycated albumin (GA) accounts for almost 80% of the circulating glycated proteins in vivo and is related to the development and progression of vascular complications in diabetes [6,7,8,9].…”

Section: Introductionmentioning

confidence: 99%

Glycated Albumin Is Superior to Hemoglobin A1c for Evaluating the Presence and Severity of Coronary Artery Disease in Type 2 Diabetic Patients

Shen¹,

Lü³

et al. 2012

Cardiology

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Objectives: This study aimed to compare the value of serum glycated albumin (GA) level versus glycated hemoglobin A_1c (HbA_1c) for evaluating the presence and severity of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). Methods: Serum GA and blood HbA_1c levels were measured in 829 consecutive T2DM patients with or without angiographically documented significant CAD (≥70% diameter stenosis). Results: Serum GA levels were higher in diabetic patients with significant CAD than in those without (20.57 ± 4.23 vs. 19.00 ± 4.48%; p < 0.001), but HbA_1c was similar in the two groups (7.74 ± 1.34 vs. 7.51 ± 1.37% p > 0.05). Compared to HbA_1c, GA correlated more closely with the sum of significant stenotic lesions (r = 0.275, p < 0.001 and r = 0.092, p = 0.019) and the extent index (r = 0.375, p < 0.001 and r = 0.091, p = 0.019). The area under the curve of GA was larger than that of HbA_1c for detecting the presence of significant CAD (0.637 vs. 0.568; p = 0.046) and 3-vessel disease (0.620 vs. 0.536; p = 0.039). GA, but not HbA_1c, was independently associated with significant CAD. Conclusions: Serum GA level is a better indicator than HbA_1c for evaluating the presence and severity of CAD and predicting major adverse cardiac events in patients with T2DM.

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Glycosylated Hemoglobin Is a Predictor of Major Adverse Cardiac Events after Drug-Eluting Stent Implantation in Patients with Diabetes Mellitus

Cited by 37 publications

References 46 publications

HbA<sub>1c</sub> Levels and Long-Term Mortality in Patients Undergoing Coronary Angiography

HbA<sub>1c</sub> Levels and Long-Term Mortality in Patients Undergoing Coronary Angiography

Percutaneous Coronary Intervention Rates and Associated Independent Predictors for Progression of Nontarget Lesions in Patients With Diabetes Mellitus After Drug-Eluting Stent Implantation

Glycated Albumin Is Superior to Hemoglobin A<sub>1c</sub> for Evaluating the Presence and Severity of Coronary Artery Disease in Type 2 Diabetic Patients

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