Zhang Jianwei, Du Yu, Hu Chengping, Liu Yan, Liu Jinxing, Gao Ang, Zhao Yingxin, Zhou Yujie
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University.
J Atheroscler Thromb. 2022 Apr 1;29(4):482-491. doi: 10.5551/jat.61358. Epub 2021 Feb 27.
The associations between increased glycated albumin (GA) in the serum and diabetic complications and mortality have been revealed in the general population. However, less is known regarding the prognostic value of GA in patients diagnosed with acute coronary syndrome (ACS).
In this study, all patients admitted for ACS who underwent a successful percutaneous coronary intervention (PCI) at our center from January 2018 to February 2019 were retrospectively examined. Clinical characteristics, laboratory results (e.g., serum GA levels), and procedural details were collected. The primary outcome included a composite of major adverse cardio-cerebral events (MACCE), such as death, myocardial infarction, stroke, and unplanned revascularization. The association between serum GA levels and clinical outcomes was tested in three multivariable models using Cox proportional hazard analysis. Subgroup analysis was performed in patients who were diagnosed with diabetes versus patients without diabetes.
A total of 1,806 ACS patients (mean age of 59.4 years; 77.8% were men; 44.9% were diagnosed with diabetes) were enrolled in this study, where the majority exhibited unstable angina (81.6%) and showed preserved left ventricular systolic function. Patients in the high GA level group were commonly female and were more likely to have metabolic disorders and to exhibit severe CAD (all p＜0.05). MACCE occurred in 126 patients (7.0%) during a mean follow-up time of 17.2 months. The cumulative risk of MACCE at the 18-month follow-up visit significantly increased in a stepwise fashion along with increased GA levels (log-rank p=0.018) in the serum. The association between serum GA levels and MACCE was further determined after adjusting traditional risk factors and hemoglobin A1c (HbA1c) (GA, per 1% increase: hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.06-1.13; GA, higher vs. lower tertial: HR 1.92, 95% CI 1.01-3.67). In a subgroup analysis, the prognostic role of serum GA only existed in diabetic patients, even when adjusting for traditional risk factors and HbA1c levels.
Elevated GA levels in the serum were associated with poor intermediate-term outcomes in low-risk ACS patients who underwent PCI, especially in patients with preexisting diabetes.
在普通人群中，血清糖化白蛋白（GA）升高与糖尿病并发症及死亡率之间的关联已被揭示。然而，关于GA在急性冠状动脉综合征（ACS）患者中的预后价值，人们了解较少。
在本研究中，对2018年1月至2019年2月在我们中心接受成功经皮冠状动脉介入治疗（PCI）的所有ACS住院患者进行回顾性检查。收集临床特征、实验室检查结果（如血清GA水平）及手术细节。主要结局包括主要不良心脑血管事件（MACCE）的复合指标，如死亡、心肌梗死、中风及非计划血管重建。使用Cox比例风险分析在三个多变量模型中检验血清GA水平与临床结局之间的关联。对糖尿病患者和非糖尿病患者进行亚组分析。
本研究共纳入1806例ACS患者（平均年龄59.4岁；77.8%为男性；44.9%被诊断为糖尿病），其中大多数表现为不稳定型心绞痛（81.6%）且左心室收缩功能保留。高GA水平组患者多为女性，更易发生代谢紊乱且表现为严重冠状动脉疾病（均p＜0.05）。在平均17.2个月的随访期内，126例患者（7.0%）发生MACCE。在18个月随访时，MACCE的累积风险随血清GA水平升高呈逐步显著增加（对数秩p = 0.018）。在调整传统危险因素和糖化血红蛋白（HbA1c）后，进一步确定血清GA水平与MACCE之间的关联（GA每增加1%：风险比[HR] 1.09，95%置信区间[CI] 1.06 - 1.13；GA，高三分位与低三分位相比：HR 1.92，95% CI 1.01 - 3.67）。在亚组分析中，即使调整传统危险因素和HbA1c水平，血清GA的预后作用仅存在于糖尿病患者中。
血清GA水平升高与接受PCI的低风险ACS患者的中期不良结局相关，尤其是在已有糖尿病的患者中。
