The Glycated Hemoglobin Alc(HbA1c) Levels And The Prognosis After PCI In Postmenopausal Women With Acute Coronary Syndrome And Diabetes

Objective: To explore the influenceof glycated hemoglobin Alc(HbA1c) levels onclinical outcomes in postmenopausal women with acute coronary syndrome and diabetes after percutaneous coronary intervention(PCI) treatment.Method: We selected 675 consecutive firsthospitalized patients with acute coronary syndrome(ACS) during January 2008 to January 2013 in the second Affiliated Hospital of Dalian Medical University. All the patients were postmenopausal women(≥55 years old) and preformed PCI treatment. According to HbA1 c levels and diagnosis of diabetes, patients were divided into 3 groups: non-diabetics(A group, N=373), good-control diabetics(B group,HbA1 c <7.0%, N=75), poor-control diabetics(C group,HbA1c≥7.0%, N=227). Patients information including age, height, weight and blood pressure was collected and body mass index(BMI) was calculated, 12 hours of fasting peripheral venous blood was taken to detect glycated hemoglobin, fasting blood glucose, blood lipids, renal function, etc.According to the image of coronary artery angiography, the number of diseased vessels was recorded and the SYNTAX score was calculated, after PCI the number and length of implanted stent was recorded. All patients were followed up for major adverse cardiovascular events(MACE) during one year after PCI. MACEs include cardiac death, nonfatal myocardial infarction and target vessel revascularization(TVR).Results:In postmenopausal women with acute coronary syndrome, low-density lipoprotein(LDL-C), total cholesterol(CHOL) and triglycerides(TRIG) were significantly increased, while, high-density lipoprotein(HDL-C) was decreased obviously in diabetic patients compared with non-diabetic patients(P<0.05).In diabetic patients, total cholesterol(CHOL) and triglycerides(TRIG) level of poor-control diabetics group was higher than good-control diabetics group(P<0.05). Moreover, SYNTAX score and proportion of patients with SYNTAX score > 23 in poor-control diabetics group were much higher than non-diabetics group and good-control diabetics group(P<0.05).The two diabetics groups comparing with non-diabetics group have obvious downtrend of left ventricular ejection fraction(LVEF),the lowest was poor-control diabetes.There was some correlation between HbA1 c and SYNTAX score(regression coefficient=0.179, P < 0.01). There wassome correlation between HbA1 c and LVEF(regression coefficient=-0.129,P<0.01).The incidence rate of MACE and TVRin poor-controlled diabetics was prominently higher than that in non-diabetics. Present uni- and multi-variable COX regression analysis for predictors of MACE. After adjustment for potential confounders, the risk of MACE in poor-control diabetics(HbA1c≥7%) was 1.342 times of the risk in non-diabetic patients(adjusted HR=1.342;IC 95%,1.153-1.521;P<0.05). The confounders included age, BMI, hypertension, LDL-C, stent length, stentnumber,SYNTAX score, LVEF, statin, ACEI/ARB. However, the risk of MACE in good-control diabetics(HbA1c < 7%) was not significantly differentfrom that of non-diabetics.Conclusion: In postmenopausal women patients with acute coronary syndrome, high level of HbA1 c is relative with severity of coronary lesionsand cardiac function declining; high level of HbA1 c in diabetics isalso relative with higherMACE rate after PCI,whichismostly driven by a higher rate of TVR; before acute coronary syndrome happened,good glycemic control to obtain HbA1 c < 7% in diabeticsisbenefit in improvement of the clinical outcomeafter PCI.