Association of Hemoglobin A1c Levels With All-Cause Mortality in Patients With Coronary Artery Disease: The Essen Coronary Artery Disease Registry
Authors' conclusion
In the present large registry of patients with established coronary artery disease (CAD) undergoing coronary revascularization therapy, HbA1c levels display a U-shaped association with all-cause mortality. In addition to patients with diabetes, also patients with CAD with very low HbA1c face increased mortality risk. Clinical trials, randomizing to different HbA1c targets are needed to define optimal HbA1c targets for patients with established CAD.
Study context
- Population
- Patients undergoing coronary revascularization therapy between 2004 and 2019 in the Essen Coronary Artery Disease registrypatients included
- Participants
- 4,700 patients
- Exposure
- Association of Hemoglobin A1c (HbA1c) with all-cause mortality
- Outcome
- All-cause mortality
- Follow-up
- Median 2.8 (IQR: 0.6-6.2) years
Methodological detailslongitudinal registry, consecutive patients
- Longitudinal registry
- Consecutive patients
Main finding
As reported in the abstract
Patients died
558 patients
8.4%
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | P value | |
|---|---|---|---|
| All-cause mortality per 1 SD change in HbA1c (multivariable)Adjusted for other cardiovascular risk factors | HR 1.16 per 1 SD change in HbA1c (95% CI 1.07–1.26) | P < 0.001 | |
| All-cause mortality by HbA1c group≤5.3%vs >5.3% to 5.6% | HR 1.52 (95% CI 1.01–2.28) | P = 0.0044 | |
| All-cause mortality by HbA1c group>5.6%-5.9%vs >5.3% to 5.6% | HR 0.96 (95% CI 0.65–1.41) | P = 0.80 | |
| All-cause mortality by HbA1c group>5.9%-6.6%vs >5.3% to 5.6% | HR 1.26 (95% CI 0.90–1.78) | P = 0.20 | |
| All-cause mortality by HbA1c group>6.6-7.8vs >5.3% to 5.6% | HR 1.38 (95% CI 0.93–2.04) | P = 0.10 | |
| All-cause mortality by HbA1c group≥7.8%vs >5.3% to 5.6% | HR 2.15 (95% CI 1.43–3.19) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
All-cause mortality by HbA1c group
- U-shaped event rate
Baseline characteristics
- Mean age
- 66.1 ± 11.4 years
- Male
- 77.1%
- Mean HbA1c
- 6.3% ± 1.2%
Original publication
Association of Hemoglobin A1c Levels With All-Cause Mortality in Patients With Coronary Artery Disease: The Essen Coronary Artery Disease Registry. JACC Adv. Published 21 February 2025. doi:10.
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