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Hemoglobin A1c and Cardiovascular Outcomes Following Percutaneous Coronary Intervention: Insights From a Large
Usman Baber1, Lorenzo Azzalini2, Reza Masoomi3
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Insights
Pre-procedural glycated hemoglobin (HbA1c) levels show a U-shaped risk for major adverse cardiac events (MACE) after PCI. Both low and high HbA1c levels are associated with increased MACE risk, driven by death and MI, respectively.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Research
Background:
- Limited data exist on the association between glycemic control (HbA1c) and ischemic risk post-percutaneous coronary intervention (PCI).
- Understanding this relationship is crucial for optimizing patient outcomes after PCI.
Purpose of the Study:
- To evaluate post-PCI outcomes in relation to pre-procedural glycated hemoglobin (HbA1c) levels.
- To investigate the association between HbA1c and major adverse cardiac events (MACE) following PCI in a large contemporary cohort.
Main Methods:
- Retrospective analysis of 13,543 patients undergoing PCI between 2009 and 2017.
- Patients categorized into five HbA1c groups: ≤5.5%, 5.6%-6.0%, 6.1%-7.0%, 7.1%-8.0%, and >8.0%.
- Primary endpoint was 1-year MACE (all-cause death or myocardial infarction).
Main Results:
- A U-shaped association was observed between pre-procedural HbA1c levels and 1-year MACE.
- Both low (≤5.5%) and high (>8.0%) HbA1c levels were linked to increased MACE risk compared to HbA1c 6.1%-7.0%.
- Low HbA1c was primarily associated with higher all-cause death rates, while high HbA1c was linked to increased myocardial infarction risk.
Conclusions:
- Pre-procedural HbA1c levels exhibit a U-shaped association with 1-year MACE risk following PCI.
- Both hypoglycemia and hyperglycemia, indicated by low and high HbA1c respectively, pose risks to patients undergoing PCI.
- These findings highlight the importance of glycemic control in cardiovascular outcomes post-PCI.
Objectives:
The aim of this study was to evaluate post-percutaneous coronary intervention (PCI) outcomes in relation to pre-procedural glycated hemoglobin (HbA1c) levels from a large, contemporary cohort.
Background:
There are limited data evaluating associations between HbA1c, a marker of glycemic control, and ischemic risk following PCI.
Methods:
All patients with known HbA1c levels undergoing PCI at a single institution between 2009 and 2017 were included. Patients were divided into 5 groups on the basis of HbA1c level: ≤5.5%, 5.6% to 6.0%, 6.1% to 7.0%, 7.1% to 8.0%, and >8.0%. The primary endpoint was major adverse cardiac events (MACE), a composite of all-cause death or myocardial infarction (MI), at 1-year follow-up.
Results:
A total of 13,543 patients were included (HbA1c ≤5.5%, n = 1,214; HbA1c 5.6% to 6.0%, n = 2,202; HbA1c 6.1% to 7.0%, n = 4,130; HbA1c 7.1% to 8.0%, n = 2,609; HbA1c >8.0%, n = 3,388). Patients with both low (HbA1c ≤5.5%) and high (HbA1c >8.0%) levels displayed an increased risk for MACE compared with those with values between 6.1% and 7.0%. Excess risk was driven primarily by higher rates of all-cause death among those with low HbA1c levels, while higher values were strongly associated with greater MI risk. Patterns of risk were unchanged among patients with serial HbA1c levels and persisted after multivariate adjustment.
Conclusions:
Among patients undergoing PCI, pre-procedural HbA1c levels display a U-shaped association with 1-year MACE risk, a pattern that reflects greater risk for death in the presence of low HbA1c (≤5.5%) and higher risk for MI with higher values (>8.0%).
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