.: ORİJİNAL ARAŞTIRMA
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
Turkiye Klinikleri J Cardiovasc Sci. 2022;34(2):62-8
doi: 10.5336/cardiosci.2022-92530
Makale Dili: EN
Tam Metin
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
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
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
REFERANSLAR:
- Gibson CM, Korjian S. Collateral circulation in chronic total occlusions: a marker of hope or hype? JACC Cardiovasc Interv. 2017;10(9):915-7. [Crossref] [PubMed]
- Shen Y, Ding FH, Dai Y, Wang XQ, Zhang RY, Lu L, et al. Reduced coronary collateralization in type 2 diabetic patients with chronic total occlusion. Cardiovasc Diabetol. 2018;17(1):26. [Crossref] [PubMed] [PMC]
- Jang WJ, Yang JH, Choi SH, Song YB, Hahn JY, Choi JH, et al. Long-term survival benefit of revascularization compared with medical therapy in patients with coronary chronic total occlusion and well-developed collateral circulation. JACC Cardiovasc Interv. 2015;8(2):271-9. [Crossref] [PubMed]
- Meier P, Hemingway H, Lansky AJ, Knapp G, Pitt B, Seiler C. The impact of the coronary collateral circulation on mortality: a meta-analysis. Eur Heart J. 2012;33(5):614-21. [Crossref] [PubMed]
- Salisbury AC, Sapontis J, Grantham JA, Qintar M, Gosch KL, Lombardi W, et al; OPEN CTO Study Group. Outcomes of chronic total occlusion percutaneous coronary intervention in patients with diabetes: insights from the OPEN CTO registry. JACC Cardiovasc Interv. 2017;10(21):2174-81. [Crossref] [PubMed]
- Zhang X, Nie M, Chen X, Liang Z, Zhao Q. Glycemic control status and long-term clinical outcomes in diabetic chronic total occlusion patients: an observational study. J Interv Cardiol. 2021;2021:5565987. [Crossref] [PubMed] [PMC]
- Pei J, Wang X, Xing Z. Traditional cardiovascular risk factors and coronary collateral circulation: a meta-analysis. Front Cardiovasc Med. 2021;8:743234. [Crossref] [PubMed] [PMC]
- Nasir K, Santos RD, Tufail K, Rivera J, Carvalho JA, Meneghello R, et al. High-normal fasting blood glucose in non-diabetic range is associated with increased coronary artery calcium burden in asymptomatic men. Atherosclerosis. 2007;195(2):e155-60. [Crossref] [PubMed]
- Sahal N, Farrag A, Ammar W, hegab A. Impact of glycated hemoglobin level on severity of coronary artery disease in non-diabetic patients. J Cardiol Curr Res 2016;7(4):00258. [Crossref]
- Ravipati G, Aronow WS, Ahn C, Sujata K, Saulle LN, Weiss MB. Association of hemoglobin A(1c) level with the severity of coronary artery disease in patients with diabetes mellitus. Am J Cardiol. 2006;97(7):968-9. [Crossref] [PubMed]
- Dar MI, Beig JR, Jan I, Shah TR, Ali M, Rather HA, et al. Prevalence of type 2 diabetes mellitus and association of HbA1c with severity of coronary artery disease in patients presenting as non-diabetic acute coronary syndrome. Egypt Heart J. 2020;72(1):66. [Crossref] [PubMed] [PMC]
- Rentrop KP, Cohen M, Blanke H, Phillips RA. Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol. 1985;5(3):587-92. [Crossref] [PubMed]
- Kis M, Guzel T. Relationship between hemoglobin A1c and fractional flow reserve lesion severity in non-diabetic patients. J Coll Physicians Surg Pak. 2022;32(1):4-8. [Crossref] [PubMed]
- Karadeniz M, Karadeniz T, Sarak T, Alp Ç. The relationship between serum homocysteine levels and development of coronary collateral circulation in patients with acute coronary syndrome. JHSM. 2020;3(2):92-6. [Crossref]
- Khaw KT, Wareham N, Bingham S, Luben R, Welch A, Day N. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med. 2004;141(6):413-20. [Crossref] [PubMed]
- Ashraf H, Boroumand MA, Amirzadegan A, Talesh SA, Davoodi G. Hemoglobin A1C in non-diabetic patients: an independent predictor of coronary artery disease and its severity. Diabetes Res Clin Pract. 2013;102(3):225-32. [Crossref] [PubMed]
- Shu W, jing J, Fu LC, Min JT, Bo YX, Ying Z, et al. The relationship between diastolic pressure and coronary collateral circulation in patients with stable angina pectoris and chronic total occlusion. Am J Hypertens. 2013;26(5):630-5. [Crossref] [PubMed]
- Demirel Y, Yıldıran H. İleri glikasyon son ürünleri ve böbrek ̇hastalıkları [Advanced glycation end products and kidney diseases]. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2018;7(1):210-7. [Link]
- Voronova V, Zhudenkov K, Helmlinger G, Peskov K. Interpretation of metabolic memory phenomenon using a physiological systems model: What drives oxidative stress following glucose normalization? PLoS One. 2017;12(2):e0171781. [Crossref] [PubMed] [PMC]
- Zicha J, Dobesová Z, Kunes J. Relative deficiency of nitric oxide-dependent vasodilation in salt-hypertensive Dahl rats: the possible role of superoxide anions. J Hypertens. 2001;19(2):247-54. [Crossref] [PubMed]
- Sinha N, Dabla PK. Oxidative stress and antioxidants in hypertension-a current review. Curr Hypertens Rev. 2015;11(2):132-42. [Crossref] [PubMed]
- Adeoye S, Abraham S, Erlikh I, Sarfraz S, Borda T, Yeung L. Anemia and hemoglobin A1c level: Is there a case for redefining reference ranges and therapeutic goals? Br J Med Pract. 2014;7(1):a706. [Link]
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