Key result
HbA1c ≥ 6.0% linked to ~78% lower odds of preserved MPRI in non-diabetic patients.
Why the study?
The relationship between elevated HbA1c and impaired microcirculation blood perfusion measured by MPRI in CMD patients with ischemic symptoms but no obstructive coronary disease was unclear.
Does elevated HbA1c increase the risk of severely reduced microcirculation blood perfusion (MPRI ≤ 1.47) in patients with coronary microvascular disease?
Observational (n=80)
Does elevated HbA1c increase the risk of severely reduced microcirculation blood perfusion (MPRI ≤ 1.47) in patients with coronary microvascular disease?
Odds Ratio: 0.219 (95% CI 0.069–0.697)
p-value: p=0.010
In non-diabetic patients with coronary microvascular disease, elevated HbA1c is associated with significantly impaired microcirculatory perfusion, highlighting the importance of early glycemic management.
HbA1c rise may flag higher CMD risk via low MPRI; leaves open whether glycemic control improves microvascular outcomes.
BACKGROUND: In coronary microvascular disease (CMD) patients, the incidence of major adverse cardiovascular events (MACEs) in patients with myocardial perfusion reserve index (MPRI) ≤ 1.47 is three times higher than that in MPRI > 1.47. We investigated whether the increase of glycated hemoglobin A1c (HbA1c) could increase the risk of MPRI ≤1.47 in diabetic and non-diabetic patients. METHODS: From November 2019, patients with ischemic symptoms but without obstructive coronary disease were screened. Use MPRI measured by stress perfusion cardiac magnetic resonance (CMR) to reflect microcirculation blood perfusion, and MPRI <2.5 were included. The patients were divided into two groups based on MPRI was greater or <1.47. The risk factors for CMD were explored using logistic regression analysis. RESULTS: A total of 80 patients with an MPRI of 1.69 ± 0.79 were included. CMD patients with an MPRI of ≤1.47(n = 33) were higher than MPRI of >1.47(n = 47) in age, presence of diabetes mellitus, fasting blood glucose levels and HbA1c levels (P < 0.05). In non-diabetic patients, increased HbA1c was associated with the risk of MPRI≤1.47 (OR = 0.017, 95%CI: 0.050-1.107, P = 0.045). Compared with non-diabetic patients with HbA1c < 6.0, non-diabetic patients with HbA1c ≥ 6.0 increased the risk of MPRI of ≤1.47 (OR = 0.219, 95%CI: 0.069-0.697, P = 0.010). In diabetic patients, HbA1c was not associated with the risk of MPRI of ≤1.47 (OR = 1.043, 95%CI: 0.269, 4.044, P = 0.952). And compared with non-diabetic patients with HbA1c <6.0, diabetic patients with HbA1c <6.0 (OR = 0.917, 95%CI: 0.233-3.610, P = 0.901) or ≥6.0 (OR = 0.326, 95%CI: 0.073-1.446, P = 0.140), the risk of MPRI ≤ 1.47 was not further increased. CONCLUSIONS: In non-diabetic patients, elevated HbA1c is related to MPRI≤1.47(a value increased incidence of MACEs). Therefore, in patients with undiagnosed diabetes, early management of glycosylated hemoglobin is very important. TRIAL REGISTRATION: This clinical trial has been registered in the Chinese clinical Trial Registry with an identifier: ChiCTR1900025810.
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Yong et al. (2023) conducted an observational in Coronary microvascular disease (n=80). Elevated HbA1c (≥ 6.0) vs. HbA1c < 6.0 was evaluated on MPRI ≤ 1.47 (OR 0.219, 95% CI 0.069-0.697, p=0.010). In non-diabetic patients, HbA1c ≥ 6.0 was associated with an increased risk of MPRI ≤ 1.47 compared to HbA1c < 6.0 (OR 0.219; 95% CI 0.069-0.697; P=0.010).
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