Prognostic Value of Hemoglobin A1c Levels in Postmenopausal Diabetic Patients Undergoing Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome
Yi Lao, Li Feng, Yong Yuan, Jin Zhang, Xuansheng Huang, Mingxing Li, Zidi Wu
Department of Cardiology, Zhong Shan Hospital of Sun Yat-sen University, Zhongshan, Guangdong, China (mainland)
Med Sci Monit 2018; 24: CLR9399-9405
The purpose of our study was to analyze the clinical value of glycosylated hemoglobin Alc (HbA1c) levels in postmenopausal women with acute coronary syndrome (ACS) and diabetes following percutaneous coronary intervention (PCI).
MATERIAL AND METHODS: A total of 173 consecutive postmenopausal patients with comorbid diabetes underwent PCI for primary ACS were enrolled in this study. Serum HbA1c levels were measured prior to PCI, and baseline clinical characteristics of all patients were collected. All patients were followed up at regular intervals for major adverse cardiovascular events (MACEs) during the first year after PCI. MACEs included cardiac death, non-fatal myocardial infarction, and target vessel revascularization (TVR).
RESULTS: At the endpoint of this study, 29 (16.8%) patients out of all 173 patients had MACEs. According to the effect of glycemic control (as indicated by HbA1c levels), all patients were stratified into a well-controlled group (HbA1c ≤7.0%, N=72) and a poorly-controlled group (HbA1c >7.0%, N=101). The incidence rate of MACEs and TVR in poorly-controlled diabetics was prominently higher than that in well-controlled diabetics (10.8% vs. 21.8%, p=0.04). In multivariable COX regression analysis, after adjustment for potential confounders, HbA1c ≥7.0% remained an independent risk predictor of MACE (HR, 2.17; 95%CI, 1.13–5.65; p<0.01).
CONCLUSIONS: In postmenopausal ACS patients with comorbid diabetes, a high level of HbA1c is associated with a higher MACE rate after PCI, which is mainly driven by a higher rate of TVR.
Keywords: acute coronary syndrome, Diabetes Mellitus, Hemoglobin A, Glycosylated, percutaneous coronary intervention, Postmenopause