Optimal glycemic control is associated with a lower rate of target vessel revascularization in treated type II diabetic patients undergoing elective percutaneous coronary intervention.
OBJECTIVE
We examined the association between glycemic control determined by preprocedural hemoglobin A1c (A1c) and the incidence of target vessel revascularization (TVR) in diabetic patients undergoing elective percutaneous coronary intervention (PCI).


BACKGROUND
Patients with diabetes mellitus (DM) have increased rates of restenosis and a worse clinical outcome after PCI than patients without DM.


METHODS
A total of 239 patients (60 without DM and 179 with DM) were enrolled in this study. Optimal glycemic control was defined as A1c < or =7%, and suboptimal control was defined as A1c >7%. Follow-up was performed at six and 12 months after the index intervention.


RESULTS
Diabetic patients with optimal glycemic control had a rate of 12-month TVR similar to that of nondiabetic patients (15% vs. 18%, p = NS). Diabetic patients with A1c >7% had a significantly higher rate of TVR than those with A1c <7% (34% vs. 15%, p = 0.02). In a multiple logistic regression analysis, A1c >7% was a significant independent predictor of TVR (odds ratio 2.87, 95% confidence interval 1.13 to 7.24; p = 0.03). Optimal glycemic control was associated with a lower rate of cardiac rehospitalization (15% vs. 31%, p = 0.03) and recurrent angina (13% vs. 37%, p = 0.002) at 12-month follow-up.


CONCLUSIONS
In diabetic patients undergoing elective PCI, optimal glycemic control (A1c < or =7%) is associated with a lower rate of TVR, cardiac rehospitalization, and recurrent angina. These data suggest that aggressive treatment of DM to achieve A1c < or =7% is beneficial in improving the clinical outcome after PCI.
Corpus
Roberto A
RA
Division of Cardiology and Biostatistics, Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri, USA. rjcorpus@yahoo.com
George
Peter B
PB
House
John A
JA
Dixon
Simon R
SR
Ajluni
Steven C
SC
Devlin
William H
WH
Timmis
Gerald C
GC
Balasubramaniam
Mamtha
M
O'Neill
William W
WW
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000706:statistics & numerical data; D001786:Blood Glucose / Q000032:analysis*; D023921:Coronary Stenosis / Q000209:etiology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D003925:Diabetic Angiopathies / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D001786:Blood Glucose