The 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.
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.
JACC Cardiovasc Interv. 2021 Feb 22;14(4):388-397. doi: 10.1016/j.jcin.2020.10.008.
The aim of this study was to evaluate post-percutaneous coronary intervention (PCI) outcomes in relation to pre-procedural glycated hemoglobin (HbA) levels from a large, contemporary cohort.
There are limited data evaluating associations between HbA, a marker of glycemic control, and ischemic risk following PCI.
All patients with known HbA levels undergoing PCI at a single institution between 2009 and 2017 were included. Patients were divided into 5 groups on the basis of HbA 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.
A total of 13,543 patients were included (HbA ≤5.5%, n = 1,214; HbA 5.6% to 6.0%, n = 2,202; HbA 6.1% to 7.0%, n = 4,130; HbA 7.1% to 8.0%, n = 2,609; HbA >8.0%, n = 3,388). Patients with both low (HbA ≤5.5%) and high (HbA >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 HbA levels, while higher values were strongly associated with greater MI risk. Patterns of risk were unchanged among patients with serial HbA levels and persisted after multivariate adjustment.
Among patients undergoing PCI, pre-procedural HbA levels display a U-shaped association with 1-year MACE risk, a pattern that reflects greater risk for death in the presence of low HbA (≤5.5%) and higher risk for MI with higher values (>8.0%).
本研究旨在评估来自大型当代队列的经皮冠状动脉介入治疗（PCI）后与术前糖化血红蛋白（HbA）水平相关的结果。
HbA 是血糖控制的标志物，其与 PCI 后缺血风险之间的关联数据有限。
纳入 2009 年至 2017 年间在一家单中心行 PCI 的所有 HbA 水平已知的患者。根据 HbA 水平将患者分为 5 组：HbA≤5.5%、5.6%至 6.0%、6.1%至 7.0%、7.1%至 8.0%和>8.0%。主要终点是 1 年随访时的主要不良心脏事件（MACE），即全因死亡或心肌梗死（MI）的复合终点。
共纳入 13543 例患者（HbA≤5.5%，n=1214；HbA 5.6%至 6.0%，n=2202；HbA 6.1%至 7.0%，n=4130；HbA 7.1%至 8.0%，n=2609；HbA>8.0%，n=3388）。HbA 水平低（HbA≤5.5%）和高（HbA>8.0%）的患者与 HbA 水平在 6.1%至 7.0%之间的患者相比，MACE 风险增加。高风险主要归因于 HbA 水平低的患者全因死亡率较高，而高值与 MI 风险增加密切相关。在连续 HbA 水平的患者中，风险模式保持不变，并且在多变量调整后仍然存在。
在接受 PCI 的患者中，术前 HbA 水平与 1 年 MACE 风险呈 U 形关联，这反映了 HbA 水平低（≤5.5%）的死亡风险增加和较高值（>8.0%）的 MI 风险增加。
