Key result
Higher preprocedural HbA1c levels were associated with a reduced risk of myocardial injury (cTnI >1x ULN) following elective PCI in diabetic patients (OR 0.85 per 1% increment).
Why the study?
Does higher preprocedural HbA1c reduce periprocedural myocardial injury in diabetic patients undergoing elective PCI?
Cohort (n=994)
No
Does higher preprocedural HbA1c reduce periprocedural myocardial injury in diabetic patients undergoing elective PCI?
Odds Ratio: 0.85 (95% CI 0.76–0.95)
p-value: p=0.005
Higher preprocedural HbA1c levels are paradoxically associated with a lower risk of periprocedural myocardial injury following elective PCI in diabetic patients.
Should not yet change preprocedural glycemic targets before elective PCI; hypothesis-generating for paradoxical HbA1c–myocardial injury association in diabetes.
BACKGROUND: Glycated 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. OBJECTIVES: The study sought to assess the relationship between HbA1c and myocardial injury following elective PCI in patients with type 2 DM. METHODS: We 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. RESULTS: Peak 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). CONCLUSIONS: The 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.
No takes yet. Share an insight, caveat, or question.
Li et al. (2014) conducted a cohort in Type 2 Diabetes Mellitus and Coronary Artery Disease (n=994). Preprocedural HbA1c levels vs. Lower HbA1c levels was evaluated on Postprocedural cTnI >1x ULN (periprocedural myocardial injury) (OR 0.85, 95% CI 0.76-0.95, p=0.005). Higher preprocedural HbA1c levels were associated with a reduced risk of myocardial injury (cTnI >1x ULN) following elective PCI in diabetic patients (OR 0.85 per 1% increment).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: