Association Between Glycosylated Hemoglobin Level and the Degree of Coronary Artery Disease in Patients With Stable Coronary Artery Disease and Type 2 Diabetes Mellitus / 中国循环杂志

ABSTRACT

Objectives: To explore the association between HbA1c level and the degree of coronary artery disease in patients with stable coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM). Methods: A total of 3 068 patients with stable coronary artery disease and T2DM treated with percutaneous coronary intervention (PCI) from 2014-07 to 2015-06 in Fuwai hospital were included in this retrospective study. Patients were divided into three groups according to SYNTAX score mild lesions group (SYNTAX score 0 to 22, n=2 661),moderate lesion group (SYNTAX score 23 to 32, n=342), and severe lesion group (SYNTAX score > 32, n=65). The relationship between the level of HbA1c and the severity of coronary lesions in patients with T2DM was analyzed using ordered Logistic regression. Results: There were 65 (2.1%) patients with SYNTAX score> 32 and 407 (13.3%) patients with SYNTAX score >22. In SYNTAX score > 32 group, mostly patients had advanced age,longer duration of hyperlipidemia and coronary disease, higher percent of old myocardial infarction and family history of coronary artery disease. Blood glucose levels and HbA1c levels increased and left ventricular ejection fraction decreasedin proportion with increasing SYNTAX score. Patients with SYNTAX score between 23 and 32 had the highest percent of the left anterior descending coronary artery and right coronary artery lesion, followed by left circumflex artery and left main trunk lesion. However, in patients with SYNTAX score> 32, the right coronary artery was the most common culprit artery. The incidence of coronary chronic total occlusions, mean lesion number and the average number of stents increased in proportion with increasing SYNTAX score (P<0.001). Multiple regression analysis showed that HbA1c level (OR3.51,95%CI2.90-4.25,P<0.001), duration of CAD (OR1.06,95%CI1.01-1.10,P<0.01) and current smoking (OR1.49, 95%CI 1.27-1.89,P<0.05)were positively associated with the severity of coronary artery lesions. Conclusions: Diffuse and severe multiple coronary artery lesions are the characteristic changes of patients with stable CAD complicating T2DM.HbA1c level is an important risk factor affecting the complexity and severity of the coronary artery lesions in these patients.