The Impact of Routine HbA1c Screening on the Prevalence of Diabetes Mellitus and Outcomes in Patients Undergoing Percutaneous Coronary Intervention

Muhammad Abu Tailakh, Doron Zahger, Michael Friger, Aviel Sidi, Efrat Mazor, Victor Novack

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: The reported rate of Diabetes Mellitus (DM) in patients undergoing Percutaneous Coronary Intervention (PCI) is 30%-40%. In 2008, the International Expert Committee recommended diabetes diagnosis by HbA1c level ≥6.5%. Our aim was to determine the prevalence of previously undiagnosed DM defined by elevated HbA1c in patients undergoing PCI and its association with 1-year clinical outcomes.
Methods: Consecutive patients undergoing PCI in a large tertiary teaching hospital were enrolled (2011-2013). HbA1c was measured before angiography. The primary outcome was 1-year Major Adverse Cardio- and Cerebrovascular Event (MACCE) defined as death, stroke, PCI or acute MI. Secondary outcomes included short term mortality.

Results: 1313 patients were enrolled (795 with ACS). DM was previously known in 528 (40.2%) patients, 232 (17.7%) had Undiagnosed DM (UDM) based on the HbA1c ≥6.5% and 553 (42.1%) did not have diabetes (Non-DM). In patients with DM HbA1c was 8.0±1.8% as compared 7.6±1.4% in patients UDM (p=0.003). UDM patients were younger (64±11) compared to DM (69±11) and non-DM (64.5±13), p<0.001. In-hospital mortality was 0.9%, 4% and 3.4% in non-DM, DM and UDM patients, respectively (p=0.004). One-year MACCE rates were 18%, 28%, and 19% in non-DM, DM, and UDM groups, respectively (p<0.001). Multivariate analysis showed that compared to non-DM (reference), the DM and UDM groups had MACCE hazard ratios of 2.11 (p<0.001) and 1.06 (p=0.55) adjusted for age, gender, smoking, previous ischemic heart disease and acute coronary syndrome.
Conclusions: Pre-procedure HbA1c testing leads to the diagnosis of previously unknown DM in a large subgroup of patients undergoing PCI. These patients represent an intermediate group as their short term mortality resembles that of patients with DM while 1-year MACCE rates are similar to non-DM patients, possibly reflecting early detection and treatment. Our findings support routine screening for DM in all patients undergoing PCI.
Original languageEnglish GB
Pages (from-to)A17659-A17659
JournalCirculation
Volume130
Issue numbersuppl2
DOIs
StatePublished - 2014

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