What is the clinical evidence from this study?

Study design: Observational. Population: Post-percutaneous coronary intervention (n=9128). Intervention: HbA1c levels vs. Different HbA1c categories (non-DM vs controlled DM). Primary outcome: Major adverse cardiovascular events (MACE) (p=0.294).

November 21, 2022Open Access

Association of Glycosylated Hemoglobin with Long-Term Adverse Cardiac Events after Percutaneous Coronary Intervention in Non Diabetes and Controlled Diabetes Patients: An Observational Study from the Korean COACT Registry

Key Result

Prediabetic and controlled diabetic HbA1c levels were not associated with significant differences in major adverse cardiovascular events after PCI (p=0.294).

Study Design

Type

Observational (n=9,128)

Multicenter

Yes

Structured PICO

Does controlled diabetes (HbA1c < 7.0%) compared to non-diabetes with varying HbA1c levels affect the risk of MACE in patients undergoing PCI?

Population

9,128 patients who underwent PCI, including non-diabetic and controlled diabetic patients, followed for a median of 22 months.

Exposure

Controlled diabetes mellitus (HbA1c < 7.0%)

Comparator

Non-diabetes mellitus patients stratified by HbA1c levels into three groups

Outcome

Major adverse cardiovascular events (MACE) at median 22 months follow-upcomposite

Diabetic patients undergoing PCI who achieve controlled HbA1c (<7.0%) have a similar long-term prognosis regarding MACE and cardiac death as non-diabetic patients.

Main Result

p-value: p=0.294

Abstract

Glycosylated hemoglobin (HbA1c) is an established marker associated with cardiovascular risk, even if it is below the diagnostic threshold for diabetes mellitus (DM). However, whether or not prediabetic and controlled diabetic levels of HbA1c are associated with increased major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) remains unclear. This observational study included a total of 9128 patients who underwent PCI in the COACT registry from eight centers in Korea. A total of 2517 non-DM patients were divided into three groups (Groups I, II, III) according to their HbA1c levels and compared with 965 controlled DM patients (HbA1c < 7.0%, Group IV). During 22 months of median follow-up, there was no significant differences in MACE (p = 0.294) and cardiac death (p = 0.105) among the four groups. In addition, there were also no significant differences in MACE (p = 0.058) between Group III and Group IV. Although patients were diagnosed as DM, they had a similar prognosis in the same range of newly diagnosed DM patients in HbA1c, if they were treated well. The results of this study suggest that intensive treatment is required to reach the Hba1c target in diabetic patients with PCI in order to have a similar prognosis to patients not previously diagnosed with diabetes.

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