• STEMI
• TIMI flow
• hemoglobin A1c
• primary PCI
• thrombus grade

• Humans
• Glycated Hemoglobin/analysis
• Glycated Hemoglobin/metabolism
• Male
• Female
• ST Elevation Myocardial Infarction/blood
• ST Elevation Myocardial Infarction/surgery
• ST Elevation Myocardial Infarction/physiopathology
• Middle Aged
• Percutaneous Coronary Intervention
• Aged
• Thrombosis/blood
• Risk Factors

• MACCE
• STEMI
• adverse outcomes
• hyperglycemia
• mortality
• revascularization

• Chronic coronary syndromes
• Glycosylated hemoglobinA1c
• High-sensitivity C-Reactive protein
• Percutaneous coronary intervention
• Prognosis

• Coronary heart disease
• Coronary stenosis
• Glycated hemoglobin A1c
• Major adverse cardiovascular event
• Type 2 diabetes mellitus

• The National Key R&D Program of China, Synthetic Biology Research
• National Natural Science Foundation of China

• HbA1c
• MACE
• coronary artery disease
• depression
• prognosis

Introduction

Diabetes mellitus (DM) is a chronic metabolic disease. It is the principal cause behind the high morbidity and mortality attributed to cardiovascular disease. This article’s objective was to determine a connection between high glycated haemoglobin levels (HbA1c) and coronary artery disease (CAD).

Materials and Methods

Cross-sectional research took place at the lady reading hospital, Peshawar, Pakistan, from 1st July 2020 to 31st December 2020. In this study, one hundred fifty-one type II diabetic patients took part. We labelled all of them as acute coronary syndrome (ACS) on arrival. Non-probability consecutive random sampling technique was used for sampling. We categorized patients based on their HbA1c levels into two groups. These groups included good glycemic control (HBA1c≤7. 5%) and patients with poor glycemic control (HBA1c ≥7.5%). We classified the angiographic results of these patients as normal coronary arteries (NCAs), single vessel disease (SVD), double vessel disease (DVD), and triple vessel disease (TVD). Continuous variables such as age, weight, height, and body mass index (BMI) between HBA1c levels were analyzed using the Mann-Whitney U test. The fisher’s exact test was performed to compare the categorical variables between the two classes.

Results

Of the total 151 patients, 89 (58.9%) were males, and the rest were female. The mean age was 55.4 ± 11.2 years. The most common risk factors were diabetes and hypertension, whereas ST-segment elevation myocardial infarction (STEMI) was the most common presentation. 107 (70.86%) patients had poor glycemic control (HbA1c>7.5%). Coronary angiographies showed TVD in 77 (50.99%) patients. Among these patients with TVD, 6 (14%) patients had good glycemic control, while 71 (66%) patients had poor glycemic control, which is significant (P≤0. 001). None of the patients with poor glycemic control had NCAs.

Conclusion

This article found a link between high levels of HbA1c and the degree of coronary artery disease (CAD) among diabetic patients. Our study’s results demonstrated that high HbA1c was related to severe CAD. It would need additional studies with a large sample size to evaluate the more profound impact of HBA1c on coronary arteries.

• acute coronary syndrome (acs)
• angiographic findings
• coronary artery disease (cad)
• glycated hemoglobin (hba1c)
• nste-acs
• ste-acs
• stemi

The predictive value of hemoglobin A1c (HbA1c) levels in non-diabetic patients with myocardial infarction undergoing percutaneous coronary intervention (PCI) is still controversial. This study aimed to evaluate whether HbA1c levels were independently associated with adverse clinical outcomes in non-diabetic patients with coronary artery disease (CAD) who had undergone PCI by performing a meta-analysis of cohort studies.

This meta-analysis included non-diabetic patients with CAD who had undergone PCI. A systematic search for publications listed in the PubMed, Embase, and Cochrane Library databases from commencement to December 2018 was conducted. Studies evaluating the adverse clinical outcomes according to abnormal HbA1c levels in non-diabetic patients diagnosed with CAD who had undergone PCI were eligible. The primary outcomes were long-term all-cause deaths and long-term major adverse cardiac events, and the secondary outcome was short-term all-cause deaths. The meta-analysis was conducted with RevMan 5.3 and Stata software 14.0. Odds ratios (ORs) were pooled using a random or fixed-effects model, depending on the heterogeneity of the included studies. Sub-group analysis or sensitivity analysis was conducted to explore potential sources of heterogeneity, when necessary.

Six prospective cohort studies involving 10,721 patients met the inclusion criteria. From the pooled analysis, abnormal HbA1c levels were associated with increased risk for long-term all-cause death (OR 1.39, 95% confidence interval [CI] 1.16–1.68, P = 0.001, I² = 45%). Sub-group analysis suggested that abnormal HbA1c levels between 6.0% and 6.5% predicted higher long-term major adverse cardiac event (including all-cause deaths, non-fatal myocardial infarction, target lesion revascularization, target vessel revascularization, recurrent acute myocardial infarction, heart failure requiring hospitalization, and stent thrombosis) risk (OR 2.05, 95% CI 1.46–2.87, P < 0.001, I² = 0). Contrarily, elevated HbA1c levels were not associated with increased risk of short-term all-cause death (OR 1.16, 95% CI 0.88–1.54, P = 0.300, I² = 0).

An abnormal HbA1c level is an independent risk factor for long-term adverse clinical events in non-diabetic patients with CAD after PCI. Strict control of HbA1c levels may improve patient survival. Further studies in different countries and prospective cohort studies with a large sample size are required to verify the association.

• AGEs, advanced glycation end products
• Advanced glycation endproducts
• CAD, coronary artery disease
• CML- N(6), carboxymethyl-lysine
• Coronary artery disease
• DM, diabetes mellitus
• Diabetes mellitus
• HbA1c, hemoglobin A1c
• Hemoglobin A1C
• LDL, low density lipoprotein
• MACCE, Major adverse cardiovascular and/or cerebrovascular events
• sRAGE, soluble AGE receptor

We investigated whether intensive glucose control after percutaneous coronary intervention (PCI) improves clinical outcomes in diabetic patients. From the Grand-DES registry, we analyzed 2576 diabetic patients (median age 66 years, male 65.6%) who underwent PCI and had at least 2 records of HbA1c during the follow-up. Patients were categorized according to the mean HbA1c (≥7% or <7%). Primary outcome was major adverse cardiovascular event (MACE), a composite of cardiac death, non-fatal myocardial infarction, and any revascularization. During a median follow-up of 33.6 months, MACE occurred in 335 (13.0%) patients. Intensive glucose control with follow-up mean HbA1c < 7.0% (42.2%; n = 1087) was not associated with lower risk of MACE, compared to control with mean HbA1c ≥ 7.0% (adjusted hazard ratio [aHR] [95% confidence interval] 1.06 [0.82–1.37], p = 0.672). In subgroup analysis, patients with sustained HbA1c of <7.0% throughout the follow-up were not associated with a lower risk of MACE compared to those with sustained HbA1c of ≥7.0% (aHR 1.15 [0.71–1.89], p = 0.566). More intensive glucose control with mean HbA1c ≤ 6.5% was not associated with lower risk of MACE, compared to loose control with a mean HbA1c ≥ 8.0% (aHR 1.15 [0.71–1.86], p = 0.583). Intensive glucose control after PCI was not associated with better clinical outcomes in diabetic patients undergoing PCI than lenient control.

HbA1c, the most commonly used indicator of chronic glucose metabolism, is closely associated with cardiovascular disease. However, the relationship between HbA1c and the mortality of acute coronary syndrome (ACS) patients has not been elucidated yet. Here, we aim to conduct a systematic review assessing the effect of HbA1c on in-hospital and short-term mortality in ACS patients.

Relevant studies reported before July 2019 were retrieved from databases including PubMed, Embase, and Central. Pooled relative risks (RRs) and the corresponding 95% confidence interval (CI) were calculated to evaluate the predictive value of HbA1c for the in-hospital mortality and short-term mortality.

Data from 25 studies involving 304,253 ACS patients was included in systematic review. The pooled RR of in-hospital mortality was 1.246 (95% CI 1.113–1.396, p: 0.000, I² = 48.6%, n = 14) after sensitivity analysis in studies reporting HbA1c as categorial valuable. The pooled RR was 1.042 (95% CI 0.904–1.202, p: 0.57, I² = 82.7%, n = 4) in random-effects model for studies reporting it as continuous valuable. Subgroup analysis by diabetic status showed that elevated HbA1c is associated increased short-term mortality in ACS patients without diabetes mellitus (DM) history and without DM (RR: 2.31, 95% CI (1.81–2.94), p = 0.000, I² = 0.0%, n = 5; RR: 2.56, 95% CI 1.38–4.74, p = 0.003, I² = 0.0%, n = 2, respectively), which was not the case for patients with DM and patients from studies incorporating DM and non-DM individuals (RR: 1.16, 95% CI 0.79–1.69, p = 0.451, I² = 31.9%, n = 3; RR: 1.10, 95% CI 0.51–2.38), p = 0.809, I² = 47.4%, n = 4, respectively).

Higher HbA1c is a potential indicator for in-hospital death in ACS patients as well as a predictor for short-term mortality in ACS patients without known DM and without DM.

• Acute coronary syndrome
• Glycated hemoglobin A
• Mortality
• Predictor

• Acute coronary syndrome
• ST-segment elevation myocardial infarction
• diabetes mellitus
• glycated hemoglobin
• hyperglycemia

• ST-segment elevation myocardial infarction
• glycated hemoglobin
• meta-analysis
• prognosis

• coronary artery disease
• glycosylated hemoglobin
• mortality
• myocardial infarction
• prediabetes

• Biomarkers/metabolism
• Coronary Artery Disease/metabolism
• Coronary Artery Disease/mortality
• Glycated Hemoglobin/metabolism
• Glycosylation
• Humans
• Observational Studies as Topic

• Biomarker
• circulating miR-126
• coronary artery disease
• microRNAs
• type 2 diabetes

• HbA1c
• blood test
• diabetes
• diagnosis
• prognosis

• Acute Coronary Syndrome/blood
• Acute Coronary Syndrome/pathology
• Adult
• Aged
• Atherosclerosis/blood
• Atherosclerosis/pathology
• Biomarkers/blood
• Female
• Glycated Hemoglobin/genetics
• Glycated Hemoglobin/metabolism
• Humans
• Male
• Middle Aged

The aim of this study was to investigate the correlation between glycosylated hemoglobin (HbA1c) levels and the severity and long-term prognosis of coronary heart disease (CHD) with stent implantation. A total of 2,825 consecutive patients with stent implantation were stratified into three groups based on the levels of HbA1c: Low HbA1c group (group A, HbA1c ≤5.9% or 41 mmol/mol; n=1,035), moderate HbA1c group (group B, 5.9%< HbA1c <6.8% or 41< HbAlc <51 mmol/mol; n=1,025) and high HbA1c group (group C, HbA1c ≥6.8% or 51 mmol/mol; n=765). The impact of HbA1c on the Gensini score and the long-term prognosis of CHD with stent implantation were observed. After an average of 1 year of follow-up of the 2,825 patients in a hospital cohort, participants with low or high HbA1c had a higher risk of major adverse cardiac events (MACE) and target lesion revascularization (TLR) compared with participants with moderate HbA1c after adjusting for multiple potential confounders (hazard ratios for low HbAlc, 1.505 and 1.478, respectively, and for high HbAlc, 1.626 and 1.522, respectively). Analysis of HbA1c as a continuous variable showed that each 1% increase of HbA1c was significantly associated with decreased risks of MACE and TLR of 53.5 and 54.2%, respectively, in those with a low HbA1c level and with increased risks of MACE and TLR of 9.5 and 9.2%, respectively, in those with a moderate or high HbA1c level, suggesting a U-shaped association between HbA1c and the risk of MACE and TLR. In conclusion, HbA1c levels, either as a continuous variable or a categorical variable, have a U-shaped correlation with MACE and TLR in CHD patients with stent implantation, even after adjustment for multiple confounders.

• Gensini score
• coronary artery disease
• glycosylated hemoglobin
• major adverse cardiac events

• ST-segment elevation myocardial infarction
• haemoglobin A1c
• primary percutaneous coronary intervention
• prognosis

• hemoglobin a1c
• stable angina pectoris
• coronary artery disease
• outcome

• Angina, Stable/blood
• Angina, Stable/pathology
• Coronary Artery Disease/blood
• Coronary Artery Disease/pathology
• Glycated Hemoglobin/metabolism
• Humans
• Prospective Studies

• Glucose intolerance
• Glycated hemoglobin
• Hyperglycemia
• Prognosis
• ST-elevation myocardial infarction

• Acute myocardial infarction
• admission glycaemia
• diabetes mellitus
• glycated haemoglobin (HbA1c)

• Analysis of Variance
• Diabetes Mellitus, Type 2/complications
• Diabetes Mellitus, Type 2/diagnosis
• Diabetes Mellitus, Type 2/mortality
• Diabetic Cardiomyopathies/complications
• Diabetic Cardiomyopathies/diagnosis
• Diabetic Cardiomyopathies/mortality
• Female
• Glycated Hemoglobin/metabolism
• Humans
• Incidental Findings
• Male
• Middle Aged
• Myocardial Infarction/blood
• Myocardial Infarction/complications
• Myocardial Infarction/mortality
• Prognosis
• Prospective Studies

Diabetes has been shown to be independent predictor of restenosis after percutaneous coronary intervention (PCI). The aim of the present study was to investigate whether a pre- and post-procedural glycaemic control in diabetic patients was related to major advance cardiovascular events (MACE) during follow up.

We evaluated 2884 consecutive patients including 2181 non-diabetic patients and 703 diabetics who underwent coronary stenting. Diabetes mellitus was defined as the fasting blood sugar concentration ≥ 126 mg/dL, or the use of an oral hypoglycemic agent or insulin at the time of admission. Diabetic patients were categorized into two groups based on their mean HbA1c levels for three measurements (at 0, 1, and 6 months following procedure): 291 (41.4%) diabetics with good glycaemic control (HbA1c ≤ 7%) and 412 (58.6%) diabetics with poor glycaemic control (HbA1c > 7%).

The adjusted risk of MACE in diabetic patients with poor glycaemic control (HbA1c > 7%) was 2.1 times of the risk in non-diabetics (adjusted HR = 2.1, 95% CI: 1.10 to 3.95, p = 0.02). However, the risk of MACE in diabetics with good glycaemic control (HbA1c ≤ 7%) was not significantly different from that of non-diabetics (adjusted HR = 1.33, 95% CI: 0.38 to 4.68, p = 0.66).

Our data suggest that there is an association between good glycaemic control to obtain HbA1c levels ≤7% (both pre-procedural glycaemic control and post-procedural) with a better clinical outcome after PCI.

• Blood Glucose/metabolism
• Diabetes Mellitus/blood
• Diabetes Mellitus/diagnosis
• Diabetes Mellitus/epidemiology
• Diabetes, Gestational/blood
• Diabetes, Gestational/diagnosis
• Female
• Genetic Testing
• Glucose Tolerance Test
• Glycated Hemoglobin/metabolism
• Guidelines as Topic
• Humans
• Male
• Prediabetic State/blood
• Prediabetic State/diagnosis
• Prediabetic State/epidemiology
• Pregnancy
• Reproducibility of Results

• hemoglobin a1c
• mortality
• coronary artery disease
• acute coronary syndrome

• Coronary Artery Disease/blood
• Coronary Artery Disease/diagnosis
• Glycated Hemoglobin/metabolism
• Glycated Hemoglobin/physiology
• Hospitalization/trends
• Humans
• Prognosis
• Randomized Controlled Trials as Topic/trends