Relationship of glycated hemoglobin levels with myocardial injury following elective percutaneous coronary intervention in patients with type 2 diabetes mellitus.

Xiao-Lin Li,Yuan-Lin Guo,Sha Li,Cheng-Gang Zhu,Bo Xu,Run-Lin Gao,Ping Qing,Jian-Jun Li,Na-Qiong Wu,Rui-Xia Xu,Li-Xin Jiang,Victor Sanchez-Margalet

doi:10.1371/journal.pone.0101719

Abstract

BackgroundGlycated hemoglobin (HbA1c) predicts clinical cardiovascular disease or cardiovascular mortality. However, the relationship between HbA1c and myocardial injury following elective percutaneous coronary intervention (PCI) in patients with type 2 diabetes mellitus (DM) has not been investigated.ObjectivesThe study sought to assess the relationship between HbA1c and myocardial injury following elective PCI in patients with type 2 DM.MethodsWe studied a cohort of consecutive 994 diabetic patients with coronary artery disease (CAD) undergoing elective PCI. Periprocedural myocardial injury was evaluated by analysis of troponin I (cTnI). The association between preprocedural HbA1c levels and the peak values of cTnI within 24 hours after PCI was evaluated.ResultsPeak postprocedural cTnI >1×upper limit of normal (ULN), >3×ULN and >5×ULN were detected in 543 (54.6%), 337 (33.9%) and 245 (24.6%) respectively. In the multivariate model, higher HbA1c levels were associated with less risk of postprocedural cTnI >1×ULN (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.76–0.95; P = 0.005). There was a trend that higher HbA1c levels were associated with less risk of postprocedural cTnI >3×ULN (OR, 0.90; 95% CI, 0.81–1.02; P = 0.088). HbA1c was not associated with the risk of postprocedural cTnI elevation above 5×ULN (OR, 0.95; 95% CI, 0.84–1.08; P = 0.411).ConclusionsThe present study provided the first line of evidence that higher preprocedural HbA1c levels were associated with less risk of myocardial injury following elective PCI in diabetic patients.

Highlights

Glycated hemoglobin (HbA1c) is an index of metabolic control of diabetes, and reflects average blood glucose levels over the previous 2–3 months, including postprandial increases in the blood glucose level [1,2]
The present study provided the first line of evidence that higher preprocedural HbA1c levels were associated with less risk of myocardial injury following elective percutaneous coronary intervention (PCI) in diabetic patients
There were no significant differences in distribution of sex, body mass index, hypertension, dyslipidemia, family history of coronary artery disease (CAD), unstable angina, prior MI, prior PCI, prior coronary artery bypass graft, high-density lipoprotein cholesterol, NT-proBNP, hemoglobin, preprocedural cardiac troponin I (cTnI) and medications at study entry among quartiles of HbA1c

Summary

Introduction

Glycated hemoglobin (HbA1c) is an index of metabolic control of diabetes, and reflects average blood glucose levels over the previous 2–3 months, including postprandial increases in the blood glucose level [1,2]. There was compelling evidence suggested that the level of HbA1c predicted clinical cardiovascular disease or cardiovascular mortality [3,4,5,6]. We are not aware of any studies elucidating the impact of preprocedural glycemic control on periprocedural myocardial injury or infarction in patients with type 2 DM who underwent elective PCI. The aim of this study was to characterize the relation between HbA1c and periprocedural myocardial injury or infarction in patients with type 2 DM undergoing elective PCI. Glycated hemoglobin (HbA1c) predicts clinical cardiovascular disease or cardiovascular mortality. The relationship between HbA1c and myocardial injury following elective percutaneous coronary intervention (PCI) in patients with type 2 diabetes mellitus (DM) has not been investigated

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Discussion

Conclusion