Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
Hemoglobin A1c is a Predictor of Poor Collateral Development in Non-Diabetic Patients with Coronary Chronic Total Occlusion: Retrospective Clinical Trial
Hemoglobin A1c, Koroner Kronik Total Oklüzyonu Olan Diyabetik Olmayan Hastalarda Zayıf Kollateral Gelişiminin Bir Prediktörüdür: Retrospektif Klinik Çalışma
Mehmet KIŞa, Tuncay GÜZELb
aDepartment of Cardiology, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
bDepartment of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Türkiye
Turkiye Klinikleri J Cardiovasc Sci. 2022;34(2):62-8
doi: 10.5336/cardiosci.2022-92530
Article Language: EN
Full Text
ABSTRACT
 Objective: Collateral circulation plays an important role for the nutrition of the myocardium in the region of chronic total occlusion (CTO), and affects clinical prognosis. It has been accepted that increased hemoglobin A1c (HbA1c) is a risk factor for cardiovascular events and subclinical atherosclerosis in individuals without diabetes mellitus. In this study, we aimed to reveal the effect of HbA1c level on coronary collateral development in the non-diabetic adult population with CTO. Material and Methods: The study included 208 non-diabetic patients out of 487 patients diagnosed with CTO on coronary angiography between March 2014 and January 2019. The patients were classified into two groups based on the Rentrop classification. Group 1 (Rentrop 0-1) (poor collateral) (90 patients) and Group 2 (Rentrop 2-3) (good collateral) (118 patients). This is a retrospective analysis. Results: The two groups were similar in terms of male gender, age, hypertension and previous history of myocardial infarction (78.9% vs. 75.4%, p=0.557; 58.9±9.9 vs. 60.8±11.2, p=0.194; 26.7% vs. 33.0%, p=0.321; and 18.9% vs. 12.7%, p=0.221; respectively). HbA1c value was statistically higher in Group 1 (5.85±0.45) than in Group 2 (5.22±0.84) (p<0.001). The ideal HbA1c cut-off value was 5.65 that was calculated by the Youden index had 77% sensitivity, and 75% specificity (Receiver operating characteristic area under curve: 0.780, 95% confidence interval: 0.717-0.844, p<0.001) for poor collateral development of CTO. Conclusion: HbA1c is a parameter that affects coronary collateral development even in non-diabetic patients. In non-diabetic patients with CTO, high HbA1c levels correlate with poor collateral development.

Keywords: Chronic total occlusion; collateral development; coronary artery disease; hemoglobin A1c
ÖZET
 Amaç: Kollateral dolaşım, kronik total oklüzyon (KTO) bölgesindeki miyokardın beslenmesinde önemli bir rol oynar ve klinik prognozu etkiler. Diabetes mellitusu olmayan bireylerde artan hemoglobin A1c (HbA1c) düzeylerinin kardiyovasküler olaylar ve subklinik ateroskleroz için risk faktörü olduğu kabul edilmiştir. Bu çalışmada, KTO tespit edilen diyabetik olmayan erişkin popülasyondaki HbA1c seviyesinin kollateral gelişimine etkisini öğrenmeyi amaçladık. Gereç ve Yöntemler: Çalışmaya Mart 2014-Ocak 2019 arasında koroner anjiyografide KTO tanısı konulan 487 hastadan diyabetik olmayan 208 hasta dâhil edildi. Hastalar Rentrop sınıflamasına göre 2 gruba ayrıldı: Grup 1 (Rentrop 0-1) (kötü kollateral) (90 hasta) ve Grup 2 (Rentrop 2-3) (iyi kollateral) (118 hasta). Bu bir retrospektif analizdir. Bulgular: İki grup yaş, erkek cinsiyet, hipertansiyon ve geçirilmiş miyokard infarktüsü öyküsü açısından benzerdi (sırasıyla %78,9'a karşı %75,4, p=0,557; 58,9±9,9'a karşı 60,8±11,2, p=0,194; %26,7'ye karşı %33,0, p=0,321 ve %18,9'a karşı %12,7, p=0,221). HbA1c değeri Grup 1'de (5,85±0,45) Grup 2'den (5,22±0,84) istatistiksel olarak anlamlı derecede daha yüksekti (p<0,001). Youden indeksi ile hesaplanan ideal HbA1c eşik değeri 5,65 saptandı ve %77 duyarlılık ve %75 özgüllük (eğri altındaki alıcı çalışma karakteristiği alanı: 0,780, %95 güven aralığı: 0,717-0,844, p<0,001) ile KTO'da zayıf kollateral gelişimi için bir öngördürücü faktör olarak saptandı. Sonuç: HbA1c, diyabetik olmayan hastalarda dâhi koroner kollateral gelişimini etkileyen bir parametredir. KTO'su olan diyabetik olmayan hastalarda yüksek HbA1c düzeyi zayıf kollateral gelişimi ile ilişkilidir.

Anahtar Kelimeler: Kronik total oklüzyon; kollateral gelişim; koroner arter hastalığı; hemoglobin A1c
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