Abstract 10644: Hemoglobin A1c Predicts Long-term Mortality Amongst Diabetic Patients Undergoing Percutaneous Coronary Intervention
Background: Diabetes adversely affects outcomes in patients undergoing percutaneous coronary intervention (PCI). The impact of glycemic control at the time of PCI on mortality is unknown.
Method: A total of 3,008 consecutive patients with diabetes undergoing PCI were identified from our registry. Characteristics and outcomes of patients were compared based on HbA1c categories (≤7, 7.1-8.0, 8.1-9.0, 9.1-10.0, & >10.0). Mortality was the primary outcome that was accessed from social security death index.
Result: Compared to low HbA1c (≤7), those with higher HbA1c (>10) were younger [56.5 vs 67.5 years], had higher BMI [32.6 vs 31.2 kg/m2], higher total cholesterol [188 vs 157 mg/dl], lower serum creatinine [1.1 vs 1.5 mg/dl] faster heart rate [78 vs 73 bpm], used insulin more often [54 vs 26%] and presented more often with STEMI [10.9 vs 5.6%]. Those with lower HbA1c (≤7) had more comorbidities (more hypertension [90.4% vs 82.5%] and renal failure [14.4%vs 7.6%]). The groups were similar in respect to ejection fraction, use of DES and successful PCIs. On covariate adjusted proportional hazard survival analysis there was increased hazard of mortality associated with higher HbA1c, statistically significant in those with HbA1c >10 (HR 1.43, p <0.001). Mortality was higher in non-insulin users with HbA1c >/= 9.1 as compared to those with HbA1c ≤7(HR 1.47, p<0.05). There was no increment in mortality amongst insulin users according to HbA1c categories. Hazard of mortality was higher in Insulin users as compared to non-insulin users, amongst those with controlled (HbA1c <8) as well as uncontrolled glycemia (HbA1c >/=8, see figure).
Conclusion: In conclusion, diabetic patients with worst glycemic control (HbA1c >10) have significantly higher long-term mortality after PCI, primarily amongst non-insulin users. Patients on Insulin have worse outcomes as compared to those who are not.
- © 2012 by American Heart Association, Inc.