Abstract 4176: Elevated Preoperative Hemoglobin A1c Level is Associated With Poor Outcomes After Percutaneous Coronary Intervention (PCI) but Not Coronary Artery Bypass Grafting (CABG): Insights From CREDO-Kyoto Registry
Background: Glucose metabolism disorders are associated with poor outcomes after coronary revascularization and hemoglobin A1c (HbA1c) level is an accepted marker for sustained glycemic control. However, impact of preoperative HbA1c level on outcomes after PCI or CABG has not been well elucidated in Japanese population.
Methods and Results: Between 2000 and 2002, a total of 9877 Japanese patients from 30 institutions who received PCI or CABG were enrolled in CREDO-Kyoto Registry. Among them, 3014 patients with multivessel coronary disease had preoperative HbA1c level obtained and entered into the present study (67±10 y.o., 2100 male). 1933 patients received PCI and 1081 CABG. Median follow-up was 3.5 years. Preoperative HbA1c levels were not different between the groups (6.4±1.5 vs. 6.4±1.5%, p=0.87). A number of diseased coronary vessels was higher in the CABG-treated group (2.7±0.5 vs. 2.4±0.5 vessels, p<0.0001). Multivariate analysis with stepwise Cox proportional hazard model showed that advanced age (>75 y.o.), male gender, heart failure, chronic kidney disease (creatinine clearance <60), and anemia (Hemoglobin <12) were significant predictor for cardiovascular death (CVD). HbA1c level was not a significant predictor for CVD (p=0.36). However, HbA1c was associated with the incidence of composite events (CVD, myocardial infarction, or stroke; p=0.0014, hazard ratio [HR]=1.1 per unit increase) and any target-vessel revascularization (p<0.0001, HR=1.1). Subsequently, impact of preoperative HbA1c level on each revascularization strategy (PCI or CABG) was evaluated. In patients received PCI, HbA1c level was associated with CVD (p=0.0016, HR=1.2), composite events (p<0.0001, HR=1.2), and furthermore, higher HbA1c was the strongest predictor for any target-vessel revascularization. On the contrary, in patients received CABG, HbA1c was not associated with CVD (p=0.28), composite events (p=0.74), and any target-vessel revascularization (p=0.10)
Conclusions: Poor preoperative glycemic control, as measured by an elevated HbA1c, is associated with poor outcomes after PCI but not CABG. CABG may be a favorable revascularization strategy in patients with multivessel coronary disease, who suffer from poor preoperative glycemic control.