Impact of Glycated Haemoglobin Level on Severity of Coronary Artery Disease in Non-Diabetic Patients

Abstract
Background: Diabetes Mellitus (DM) is a major and well established risk factor for macrovascular diseases. Glycated haemoglobin (HbA1c) was more strongly associated with the risks of Atherosclerotic Coronary Vascular Disease (ASCVD).
Aim of the Study: This study was designed to assess the relationship between the level of HbA1c and the severity of Coronary Artery Disease (CAD) which was assessed by Gensini score and Syntax score among non-diabetic patients who were referred to elective coronary angiography.
Patient and Methods: A total number of 104 non diabetic patients who were referred to elective coronary angiography at Maadi Military Hospital within the period from June 2015 to June 2016 were included in this study. All patients were subjected to history taking, full clinical examination, venous samples were withdrawn for glycated haemoglobin, haemo-globin, serum creatinine, high density lipoprotien, low density lipoprotien, total cholesterol, triglycerides, and creatinine clearance was calculated. Electrocardiogram was done, and coronary angiography was recorded, and Syntax and Gensini scores were calculated.
Result: In high risk group, male gender represented 52.1% (n=25) of the patients, and most of this group were old age with mean age ± SD (56.83±7.18) years, and they were over weighted with mean body mass index ± SD (29.02±5.07), and hypertensive patients represented 50.0% (n=24) of this group and smokers represented 18.8% (n=9). In low risk group, male gender represented 55.4% (n=3 1) of the patients, and most of this group were old age with mean age ± SD (55.02± 7.64) years, and they were over weighted with mean body mass index ± SD (29.29±4.14), and hypertensive patients represented 58.9% (n=33) and smokers represented 37.5% of this group (n=21).
There was a high statistically significant difference be-tween the two groups as regard right coronary artery lesion, left circumflex artery lesion, Gensini score and Syntax score as p<0.001, and there was a statistically significant difference between the two groups as regard left main lesion as p<0.05, and there was a positive correlation between HbA1c with Gensini score and Syntax score as r=0.74 and 0,77 respectively.
The accuracy of Gensini score equals 85% by 81.2% sensitivity and 83.9% specificity at cut off predictive value <59 to discriminate between the two groups. The accuracy of Syntax score equals 88% by 87,5% sensitivity and 91.1% specificity at cut off predictive value <12 to discriminate between the two groups.
Conclusion and Recommendation: There was a positive correlation between level of glycated haemoglobin and severity of coronary artery disease which was assessed by Syntax score and Gensini score in non-diabetics who were referred to elective coronary angiography, and after this study we recommend to use HbA1c as a complimentary parameter to traditional risk factors to predict the severity of CAD.