Glycated Hemoglobin as a Long-Term Predictor of Cardiovascular Outcomes in Patients Undergoing Carotid Endarterectomy

Background Several biomarkers are known to predict long-term complications after non-cardiac surgery, including major adverse cardiovascular events (MACE), myocardial infarction, and death. Carotid endarterectomy (CEA), a low to medium-risk procedure for carotid stenosis, aims to prevent stroke. Glycated hemoglobin (HbA1c) may hold prognostic value for MACE. This study evaluates the role of HbA1c in predicting all-cause mortality and MACE in patients undergoing CEA.Methods A post hoc analysis was conducted using data from a prospective database of patients who underwent CEA under regional anesthesia at a tertiary referral center between January 2014 and December 2023. Patients with HbA1c measured within three months prior to surgery were included and divided into two groups (HbA1c <6.5% vs. ≥6.5%). Kaplan-Meier survival and multivariable Cox regression analyses assessed the impact of HbA1c on outcomes. The primary outcome was the incidence of long-term MACE and all-cause mortality. Secondary outcomes included stroke, acute myocardial infarction (AMI), acute heart failure (AHF), and major adverse limb events (MALE).Results A total of 65 patients (mean age 71.4 ± 8.5 years; 81.5% male) were included, with a median follow-up of 30 months. Patients with HbA1c ≥6.5% were significantly younger. Elevated HbA1c was associate with trend toward more stroke risk (log-rank p = 0.045, HR: 3.2 (CI: 0.96-10.7, p = 0.059) HbA1c was an independent predictor of MALE (aHR: 3.387, p = 0.037), while its association with stroke did not reach significance (p = 0.059).Conclusion HbA1c appears to be a useful, accessible biomarker for vascular risk stratification in patients undergoing CEA.