Abstract
Background: There is controversy regarding the long-term effect of glycemic control on the clinical outcomes after percutaneous coronary intervention (PCI) in diabetes patients with coronary artery disease (CAD). We aimed to evaluate the long-term outcomes of patients with diabetes who underwent PCI, according to the mean hemoglobin A1c (HbA1c) level after PCI.Methods: We retrospectively evaluated 675 diabetes patients with CAD treated with PCI from 2010 to 2013. We categorized the study population into three groups based on the mean observed HbA1c levels during the follow-up duration, as follows: aggressive control (AC) group (HbA1c level <6.5%, n=148), moderate control (MC) group (HbA1c level ≥6.5% and <7.0%, n=138), and uncontrolled (UC) group (HbA1c level ≥7.0%, n=389). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), defined as cardiac death, myocardial infarction, repeat target vessel revascularization, and stroke. The median follow-up duration was 74.1 (32.6–85.0) months.Results: The mean HbA1c level of the AC group was significantly lower than that of the MC and UC groups (6.04±0.36% vs. 6.74±0.14% vs. 8.39±1.20%, p<0.001). Patients in the AC group were older than those in the MC and UC groups (66.2±10.0 vs. 64.4±11.3 vs. 62.9±10.4 years, p=0.004); however, the other clinical characteristics were similar among the groups. The incidence of MACCEs was significantly lower in the AC group than in the MC and UC groups (16.0% vs. 24.3% vs. 26.3%, p=0.010), mostly driven by the incidence of stroke (4.4% vs. 14.0% vs. 11.0%, p=0.013). Multivariate Cox regression analysis showed that only the AC group was associated with a reduced rate of MACCEs (hazard ratio 0.513, 95% confidence interval 0.326–0.808, p=0.004) compared with the UC group.Conclusion: Our study showed that intensive glycemic control (HbA1c level <6.5%) is associated with improved clinical outcomes after PCI in patients with diabetes.
Long-term effects of the mean hemoglobin A1c levels after percutaneous coronary intervention in patients with diabetes
