Long-term effects of the mean hemoglobin A1c levels after percutaneous coronary intervention in patients with diabetes

• Published in: The Korean journal of internal medicine 2021, 36(6), , pp.1365-1376
• Main Authors: Bae, Jaekyung, Yoon, Ji-Hyung, Lee, Jung-Hee, Nam, Jong-Ho, Lee, Chan-Hee, Son, Jang-Won, Kim, Ung, Park, Jong-Seon, Shin, Dong-Gu
• Format: Article
• Language: English
• Subjects: coronary artery disease; diabetes mellitus; glycated hemoglobin a; Original; percutaneous coronary intervention; treatment outcome; 내과학
• ISSN: 1226-3303; 2005-6648
• DOI: 10.3904/kjim.2020.694

Background/Aims: The clinical benefit of strict blood glucose-lowering therapy for patients with coronary artery disease (CAD) is still debated. We aimed to evaluate the long-term outcomes of patients with diabetes who underwent percutaneous coronary intervention (PCI), according to the mean hemoglobin A1c (HbA1c) level after PCI.Methods: We evaluated 675 diabetes patients with CAD treated with PCI. 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.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). 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. 11.4%, p = 0.013). Multivariate Cox regression analysis showed that only the AC group was associated with a reduced rate of MACCEs (hazard ratio, 0.499; 95% confidence interval, 0.316 to 0.786; p = 0.004) compared with the UC group.Conclusions: Our study showed that intensive glycemic control (HbA1c level < 6.5%) is associated with improved clinical outcomes after PCI in patients with diabetes.