Glycosylated hemoglobin (HbA1c) levels and clinical outcomes in diabetic patients following coronary artery stenting

Kassaian, Seyed Ebrahim; Goodarzynejad, Hamidreza; Boroumand, Mohammad Ali; Salarifar, Mojtaba; Masoudkabir, Farzad; Mohajeri-Tehrani, Mohammad Reza; Pourhoseini, Hamidreza; Sadeghian, Saeed; Ramezanpour, Narges; Alidoosti, Mohammad; Hakki, Elham; Saadat, Soheil; Nematipour, Ebrahim

doi:10.1186/1475-2840-11-82

Cited by 88 publications

(84 citation statements)

References 48 publications

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“…The findings of cohort studies (18)(19)(20)(21)(22) investigating the relation between HbA 1c level and new cardiovascular events in patients with and without type 2 diabetes after cardiac interventions for coronary artery disease are in line with our findings. In these studies (18,21,22).…”

Section: Discussionsupporting

confidence: 90%

The Relation Between HbA1c and Cardiovascular Events in Patients With Type 2 Diabetes With and Without Vascular Disease

et al. 2015

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OBJECTIVEPoor glycemic control is related to vascular events in patients with type 2 diabetes, but the presence of vascular disease might influence this relation. We evaluated the relation between glycemic control (HbA 1c level) and new cardiovascular events and mortality in patients with type 2 diabetes, with and without vascular disease. RESEARCH DESIGN AND METHODSIn a cohort of 1,687 patients with type 2 diabetes enrolled in the Second Manifestations of Arterial Disease (SMART) study, the continuous relation between HbA 1c and cardiovascular events (composite of myocardial infarction, stroke, and vascular mortality) and all-cause mortality was evaluated with Cox proportional hazard analyses stratified for the presence of vascular disease. RESULTSDuring a median follow-up time of 6.1 years (interquartile range 3.1-9.5 years), a new cardiovascular event developed in 293 patients and 340 patients died. In all patients, the hazard ratio (HR) of the relation between HbA 1c level and cardiovascular events was 1.06 (95% CI 0.97-1.17 CONCLUSIONSIn patients with type 2 diabetes, there is a modest, but not statistically significant, relation between HbA 1c level and cardiovascular events, and, as there was no statistically significant interaction, this relation was not different for patients with or without clinical manifestation of vascular disease.Strict glycemic control has been proposed as an important means to lower the risk of both microvascular and macrovascular complications of type 2 diabetes. A strong relation between glycemic control and microvascular complications (nephropathy, retinopathy, and neuropathy) and macrovascular complications is observed in patients

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Section: Discussionsupporting

confidence: 90%

The Relation Between HbA1c and Cardiovascular Events in Patients With Type 2 Diabetes With and Without Vascular Disease

et al. 2015

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“…First, hyperglycemia may induce the expression of the surface adhesion molecule P-selectin, the glycation of platelet surface proteins with a consequent membrane fl uidity decrease and a platelet adhesion increase, the activation of protein kinase C, and may exert a direct osmotic effect [9][10][11][12]. Hyperglycemia may also promote atherothrombosis via oxidation of amino groups, formation of advanced glycation end-products, endothelial dysfunction, subendothelial cellular proliferation, and increased matrix expression [12,13].…”

Section: Freedom Trial: a Brief Synopsis Of The Offi Cial Resultsmentioning

confidence: 99%

“…Other abnormalities that contribute to the enhanced platelet adhesion and activation in DM include the increased expression of the platelet receptor glycoprotein (GP) IIb/IIIa, up-regulation of platelet P2Y 12 receptor signalling, increased platelet turnover, and enhanced oxidative stress. In addition, insulin resistance may increase intracellular calcium concentration and impair the response to nitric oxide [9][10][11][12][13].…”

Section: Freedom Trial: a Brief Synopsis Of The Offi Cial Resultsmentioning

confidence: 99%

Optimal revascularization in diabetes after the FREEDOM trial: Were the controversies finally settled?

Tenenbaum

Fisman

2013

Cardiol J

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“…Therefore, patients with high follow-up HbA1c would be classified as the control group if the follow-up HbA1c level was lower than the baseline level. Kassaian et al 17 reported an association between good glycemic control (HbA1c levels ≤7.0%) and positive clinical outcomes after PCI. However, definite conclusions on the effects of glycemic control on long-term outcomes cannot be drawn because of the extremely low event rates and short follow-up duration.…”

Section: Discussionmentioning

confidence: 99%

Glycemic Control Status After Percutaneous Coronary Intervention and Long-Term Clinical Outcomes in Patients With Type 2 Diabetes Mellitus

Hwang

Lee

Song

et al. 2017

Circ: Cardiovascular Interventions

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C ardiovascular disease is the major cause of mortality in patients with type 2 diabetes mellitus.1 Although intensive therapy to lower glucose has consistently been reported to reduce microvascular complications of type 2 diabetes mellitus, 2,3 whether intensive glycemic control reduces macrovascular complications and improves clinical outcomes remains controversial. 4,5 Limited data are available regarding the effect of intensive glycemic control for secondary prevention in patients with established cardiovascular disease, especially in those undergoing percutaneous coronary intervention (PCI). The association between baseline glycosylated hemoglobin A (HbA1c) at the time of PCI and clinical outcomes among diabetic patients was reported in a few studies with conflicting results. 6,7 Moreover, it is not known if glycemic control after PCI can improve cardiovascular outcomes, which is a more important issue than glycemic status at the time of PCI. Because diabetic patients account for more than a quarter of all patients undergoing PCI and have worse outcomes compared with nondiabetic patients, 8,9 determining the optimal strategy for glycemic control in these patients after PCI has substantial clinical implications. Therefore, we investigated the association between glycemic status as estimated by HbA1c measured 2 years after PCI and long-term cardiovascular outcomes in type 2 diabetic patients undergoing PCI using drug-eluting stents (DES).Background-Data on the association between glycemic control after percutaneous coronary intervention and clinical outcomes are limited and controversial in diabetic patients. Methods and Results-We studied 980 patients with type 2 diabetes mellitus undergoing percutaneous coronary intervention using drug-eluting stents. Based on 2-year glycosylated hemoglobin A (HbA1c) levels, we divided patients into 2 groups of HbA1c<7.0 (n=489) and HbA1c≥7.0 (n=491). Propensity score-matched analysis was performed in 322 pairs. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of cardiac death, myocardial infarction, repeat revascularization, or stroke. Median follow-up duration was 5.4 years. The 7-year incidence of MACCE was lower in the HbA1c<7.0 group than in the HbA1c≥7.0 group (26.9% versus 40.3%; adjusted hazard ratio, 0.75; 95% confidence interval, 0.57-0.98; P=0.03). After propensity score matching, the 7-year incidence of MACCE was still lower in the HbA1c<7.0 group than in the HbA1c≥7.0 group (27.5% versus 37.4%; hazard ratio, 0.71; 95% confidence interval, 0.52-0.97; P=0.03), mainly because of a reduction in repeat revascularization (19.9% versus 29.5%; hazard ratio, 0.66; 95% confidence interval, 0.47-0.93; P=0.02). In subgroup analyses, the benefit of glycemic control for MACCE was more prominent in patients with residual SYNTAX score (Synergy Between PCI With Taxus and Cardiac Surgery) >4 than in those with the residual SYNTAX score ≤4 (P interaction =0.004). Conclusions-HbA1c<7.0 measured 2 years after percutaneous cor...

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Glycosylated hemoglobin (HbA1c) levels and clinical outcomes in diabetic patients following coronary artery stenting

Cited by 88 publications

References 48 publications

The Relation Between HbA1c and Cardiovascular Events in Patients With Type 2 Diabetes With and Without Vascular Disease

The Relation Between HbA1c and Cardiovascular Events in Patients With Type 2 Diabetes With and Without Vascular Disease

Optimal revascularization in diabetes after the FREEDOM trial: Were the controversies finally settled?

Glycemic Control Status After Percutaneous Coronary Intervention and Long-Term Clinical Outcomes in Patients With Type 2 Diabetes Mellitus

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