Abstract
BackgroundDiabetes has been shown to be independent predictor of restenosis after percutaneous coronary intervention (PCI). The aim of the present study was to investigate whether a pre- and post-procedural glycaemic control in diabetic patients was related to major advance cardiovascular events (MACE) during follow up.MethodsWe evaluated 2884 consecutive patients including 2181 non-diabetic patients and 703 diabetics who underwent coronary stenting. Diabetes mellitus was defined as the fasting blood sugar concentration ≥ 126 mg/dL, or the use of an oral hypoglycemic agent or insulin at the time of admission. Diabetic patients were categorized into two groups based on their mean HbA1c levels for three measurements (at 0, 1, and 6 months following procedure): 291 (41.4%) diabetics with good glycaemic control (HbA1c ≤ 7%) and 412 (58.6%) diabetics with poor glycaemic control (HbA1c > 7%).ResultsThe adjusted risk of MACE in diabetic patients with poor glycaemic control (HbA1c > 7%) was 2.1 times of the risk in non-diabetics (adjusted HR = 2.1, 95% CI: 1.10 to 3.95, p = 0.02). However, the risk of MACE in diabetics with good glycaemic control (HbA1c ≤ 7%) was not significantly different from that of non-diabetics (adjusted HR = 1.33, 95% CI: 0.38 to 4.68, p = 0.66).ConclusionsOur data suggest that there is an association between good glycaemic control to obtain HbA1c levels ≤7% (both pre-procedural glycaemic control and post-procedural) with a better clinical outcome after PCI.
Highlights
Diabetes has been shown to be independent predictor of restenosis after percutaneous coronary intervention (PCI)
The introduction of drug-eluting stents has reduced the rates of restenosis and clinical events after percutaneous coronary intervention (PCI), since the diabetes mellitus has been proved to be a strong risk factor for in-stent restenosis [2,3,4], restenosis after stent implantation
The higher rates of restenosis in diabetic patients might be partly explained by exaggerated neointimal proliferation after stent implantation due to hyperinsulinemic state of diabetes [11]
Summary
Diabetes has been shown to be independent predictor of restenosis after percutaneous coronary intervention (PCI). The aim of the present study was to investigate whether a pre- and post-procedural glycaemic control in diabetic patients was related to major advance cardiovascular events (MACE) during follow up. The introduction of drug-eluting stents has reduced the rates of restenosis and clinical events after percutaneous coronary intervention (PCI), since the diabetes mellitus has been proved to be a strong risk factor for in-stent restenosis [2,3,4], restenosis after stent implantation. There is consistent evidence that optimal glycaemic control (defined as HbA1c ≤ 7%) results in a lower incidence of microvascular complications in both type 1 and type 2 diabetes mellitus [14]. The corollary that optimal glycaemic control in diabetic patients would lead to a similar improvement in clinical outcome of PCI has not been extensively investigated. While there are conflicting data regarding the effect of preprocedural glycaemic control on outcome of PCI, there is limited data about the impact of post-procedural glycaemic control, beginning at the time of PCI and continuing afterwards, on incidence of MACEs after PCI
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