Association Between Glycosylated Hemoglobin Level and Cardiovascular Outcomes in Diabetic Patients After Percutaneous
Jia Zheng1, Jing Cheng, Qian Zhang
1From the Department of Endocrinology (JZ, QZ, CQ, TW, XX), Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Diabetes Research Center of Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing; The Key Laboratory of Cardiovascular Remodeling and Function Research (JC), Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, P.R. China.
Insights
Higher glycosylated hemoglobin (HbA1c) levels in diabetic patients predict increased risks of target vessel revascularization and nonfatal myocardial infarction after percutaneous coronary intervention (PCI). Further research is needed to confirm these findings.
Area of Science:
- Cardiology
- Endocrinology
- Medical Diagnostics
Background:
- Glycosylated hemoglobin (HbA1c) is a key indicator of long-term glycemic control.
- Diabetic patients undergoing percutaneous coronary intervention (PCI) face elevated risks of adverse cardiovascular events.
- The predictive value of HbA1c levels for post-PCI complications in diabetics requires further elucidation.
Purpose of the Study:
- To systematically review and perform a meta-analysis on the association between HbA1c levels and clinical outcomes in diabetic patients following PCI.
- To evaluate the risk of specific adverse events, including target vessel revascularization, myocardial infarction, major adverse cardiovascular events, mortality, and in-stent thrombosis.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, and Cochrane Library databases up to December 2015.
- Data from eight studies involving 3290 diabetic patients post-PCI were extracted and analyzed using RevMan 5.3 software.
- Summary odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the associations.
Main Results:
- Higher HbA1c levels were significantly associated with an increased risk of target vessel revascularization progression (OR 1.36, 95% CI 1.03-1.82).
- A significant correlation was found between elevated HbA1c and a higher risk of nonfatal myocardial infarction post-PCI (OR 2.47, 95% CI 1.38-4.44).
- No significant associations were observed for major adverse cardiovascular events, all-cause mortality, cardiac death, or in-stent thrombosis.
Conclusions:
- Elevated HbA1c levels may indicate a higher risk for target vessel revascularization progression and nonfatal myocardial infarction in diabetic patients after PCI.
- The current meta-analysis provides evidence for the prognostic value of HbA1c in this patient population.
- Larger-scale studies are warranted to definitively confirm these associations and guide clinical practice.
Abstract:
Glycosylated hemoglobin (HbA1c) is a critical measure of glycemic control, which may be a reliable predictor of complications after percutaneous coronary intervention (PCI). This systematic review and meta-analysis evaluates the association between HbA1c levels and clinical outcomes in diabetic patients after PCI.Pubmed, Embase, and Cochrane Library databases (dated to December 2015) were screened for relevant studies. Appropriate diabetic cases and controls, assessed using blood HbA1c levels, were extracted, and statistical analysis was conducted using RevMan 5.3 software. Summary odds ratios (ORs) with 95% confidence intervals (CIs) were used to calculate the associations between HbA1c levels and clinical outcomes in diabetic patients after PCI. Ethics review and approval was not necessary because this systematic meta-analysis did not involve any direct human trials or animal experiments.Eight studies that reported HbA1c levels for a total of 3290 diabetic subjects after PCI were included in this meta-analysis. Comprehensive integration and analysis revealed a significant correlation between higher HbA1c levels and the risk of target vessel revascularization progression (OR 1.36, 95% CI 1.03-1.82) and nonfatal myocardial infarction after PCI (OR 2.47, 95% CI 1.38-4.44). However, no significant association was found between HbA1c levels and major adverse cardiovascular events (OR 1.02, 95% CI 0.83-1.27), all-cause mortality (OR 0.73, 95% CI 0.52-1.02), cardiac death (OR 1.12, 95% CI 0.62-2.03), or in-stent thrombosis (OR 0.65, 95% CI 0.23-1.87) among diabetic patients after PCI. Sensitivity analysis indicated a statistically robust result and revealed no publication bias.Our meta-analysis demonstrated that blood HbA1c levels might be associated with higher risks of target vessel revascularization progression and nonfatal myocardial infarction among diabetic patients after PCI. However, further studies with larger sample sizes are required to verify the association.
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