Song Wen, Zehan Huang, Lingbing Meng, Qiheng Wan, Xingjie Huang, Yuqing Huang, Bin Zhang, Jing Wang
In this retrospective cohort study, elevated HGI was independently and linearly associated with heightened long-term adverse clinical outcomes after successful CTO-PCI. These findings suggest that HGI may have potential as a prognostic marker for risk stratification in this population; however, prospective validation is required before clinical application.
BACKGROUND: Even after technically successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO), patients face persistent excess cardiovascular risk. The hemoglobin glycation index (HGI), a marker of interindividual glycation heterogeneity, has not been studied in this setting.
METHODS: We enrolled 1, 513 patients who had undergone successful CTO-PCI between 2011 and 2023 at Guangdong Provincial People's Hospital. HGI was computed as the difference between the measured HbA1c and the value predicted from fasting plasma glucose using a cohort-derived linear equation. The primary composite outcome included cardiovascular death, non-fatal myocardial infarction, and stroke (cardiovascular events, CVEs). Secondary outcomes were all-cause and cardiovascular death. Multivariable Cox regression and restricted cubic splines were applied to assess associations.
RESULTS: During a median 810-day follow-up, 83 (5.5%) all-cause deaths, 53 (3.5%) cardiovascular deaths, and 73 (4.8%) CVEs occurred. After full adjustment, Each 1-standard deviation increment in HGI conferred an independent hazard of 1.34 (95% CI 1.14-1.58) for all-cause mortality, 1.52 (95% CI 1.25-1.83) for cardiovascular mortality, and 1.42 (95% CI 1.15-1.61) for CVEs. Compared with the lowest tertile, patients in the highest HGI tertile exhibited a 2.41-fold (95% CI 1.37-4.25, P = 0.002), 4.13-fold (95% CI 1.91-8.94, P<0.001), and 2.73-fold (95% CI 1.47-5.07, P = 0.001) higher risk of all-cause mortality, cardiovascular mortality, and CVEs, respectively. RCS analysis revealed a linear dose-response relationship, with a secondary exploratory threshold effect identified at HGI = -0.15 for CVEs (HR 2.05, 95% CI 1.22-3.44).
CONCLUSIONS: In this retrospective cohort study, elevated HGI was independently and linearly associated with heightened long-term adverse clinical outcomes after successful CTO-PCI. These findings suggest that HGI may have potential as a prognostic marker for risk stratification in this population; however, prospective validation is required before clinical application.