title: Glycemic Control Status After Percutaneous Coronary Intervention and Long-Term Clinical Outcomes in Patients With Type 2 Diabetes Mellitus.
abstract: BACKGROUND
  Data on the association between glycemic control after percutaneous coronary intervention and clinical outcomes are limited and controversial in diabetic patients.
  
  
  RESULTS
  We studied 980 patients with type 2 diabetes mellitus undergoing percutaneous coronary intervention using drug-eluting stents. Based on 2-year glycosylated hemoglobin A (HbA1c) levels, we divided patients into 2 groups of HbA1c<7.0 (n=489) and HbA1c≥7.0 (n=491). Propensity score-matched analysis was performed in 322 pairs. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of cardiac death, myocardial infarction, repeat revascularization, or stroke. Median follow-up duration was 5.4 years. The 7-year incidence of MACCE was lower in the HbA1c<7.0 group than in the HbA1c≥7.0 group (26.9% versus 40.3%; adjusted hazard ratio, 0.75; 95% confidence interval, 0.57-0.98;P=0.03). After propensity score matching, the 7-year incidence of MACCE was still lower in the HbA1c<7.0 group than in the HbA1c≥7.0 group (27.5% versus 37.4%; hazard ratio, 0.71; 95% confidence interval, 0.52-0.97;P=0.03), mainly because of a reduction in repeat revascularization (19.9% versus 29.5%; hazard ratio, 0.66; 95% confidence interval, 0.47-0.93;P=0.02). In subgroup analyses, the benefit of glycemic control for MACCE was more prominent in patients with residual SYNTAX score (Synergy Between PCI With Taxus and Cardiac Surgery) >4 than in those with the residual SYNTAX score ≤4 (Pinteraction=0.004).
  
  
  CONCLUSIONS
  HbA1c<7.0 measured 2 years after percutaneous coronary intervention was associated with a reduced rate of MACCE. Our data suggest that high HbA1c levels 2 years after percutaneous coronary intervention may identify a population at increased risk of adverse events, especially repeat revascularization.
authors.affiliation: From the Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.K.H., Seung Hwa Lee, Y.B.S., M.J.J., T.K.P., S.-H.C., J.H.Y., J.-H.C., Sang Hoon Lee, H.-C.G., J.-Y.H.); Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada (K.C.).
authors.forename: Jin Kyung
authors.initials: JK
authors.lastname: Hwang
authors.affiliation: From the Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.K.H., Seung Hwa Lee, Y.B.S., M.J.J., T.K.P., S.-H.C., J.H.Y., J.-H.C., Sang Hoon Lee, H.-C.G., J.-Y.H.); Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada (K.C.).
authors.forename: Seung Hwa
authors.initials: SH
authors.lastname: Lee
authors.affiliation: From the Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.K.H., Seung Hwa Lee, Y.B.S., M.J.J., T.K.P., S.-H.C., J.H.Y., J.-H.C., Sang Hoon Lee, H.-C.G., J.-Y.H.); Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada (K.C.).
authors.forename: Young Bin
authors.initials: YB
authors.lastname: Song
authors.affiliation: From the Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.K.H., Seung Hwa Lee, Y.B.S., M.J.J., T.K.P., S.-H.C., J.H.Y., J.-H.C., Sang Hoon Lee, H.-C.G., J.-Y.H.); Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada (K.C.).
authors.forename: Joonghyun
authors.initials: J
authors.lastname: Ahn
authors.affiliation: From the Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.K.H., Seung Hwa Lee, Y.B.S., M.J.J., T.K.P., S.-H.C., J.H.Y., J.-H.C., Sang Hoon Lee, H.-C.G., J.-Y.H.); Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada (K.C.).
authors.forename: Keumhee
authors.initials: K
authors.lastname: Carriere
authors.affiliation: From the Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.K.H., Seung Hwa Lee, Y.B.S., M.J.J., T.K.P., S.-H.C., J.H.Y., J.-H.C., Sang Hoon Lee, H.-C.G., J.-Y.H.); Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada (K.C.).
authors.forename: Mi Ja
authors.initials: MJ
authors.lastname: Jang
authors.affiliation: From the Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.K.H., Seung Hwa Lee, Y.B.S., M.J.J., T.K.P., S.-H.C., J.H.Y., J.-H.C., Sang Hoon Lee, H.-C.G., J.-Y.H.); Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada (K.C.).
authors.forename: Taek Kyu
authors.initials: TK
authors.lastname: Park
authors.affiliation: From the Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.K.H., Seung Hwa Lee, Y.B.S., M.J.J., T.K.P., S.-H.C., J.H.Y., J.-H.C., Sang Hoon Lee, H.-C.G., J.-Y.H.); Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada (K.C.).
authors.forename: Seung-Hyuk
authors.initials: SH
authors.lastname: Choi
authors.affiliation: From the Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.K.H., Seung Hwa Lee, Y.B.S., M.J.J., T.K.P., S.-H.C., J.H.Y., J.-H.C., Sang Hoon Lee, H.-C.G., J.-Y.H.); Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada (K.C.).
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Yang
authors.affiliation: From the Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.K.H., Seung Hwa Lee, Y.B.S., M.J.J., T.K.P., S.-H.C., J.H.Y., J.-H.C., Sang Hoon Lee, H.-C.G., J.-Y.H.); Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada (K.C.).
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
authors.affiliation: From the Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.K.H., Seung Hwa Lee, Y.B.S., M.J.J., T.K.P., S.-H.C., J.H.Y., J.-H.C., Sang Hoon Lee, H.-C.G., J.-Y.H.); Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada (K.C.).
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Lee
authors.affiliation: From the Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.K.H., Seung Hwa Lee, Y.B.S., M.J.J., T.K.P., S.-H.C., J.H.Y., J.-H.C., Sang Hoon Lee, H.-C.G., J.-Y.H.); Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada (K.C.).
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
authors.affiliation: From the Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.K.H., Seung Hwa Lee, Y.B.S., M.J.J., T.K.P., S.-H.C., J.H.Y., J.-H.C., Sang Hoon Lee, H.-C.G., J.-Y.H.); Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada (K.C.). jyhahn@skku.edu.
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
mesh_terms: D000368:Aged; D000416:Alberta / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D038321:Glycemic Index; D006801:Humans; D015994:Incidence; D008297:Male; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: HbA1c; coronary intervention; diabetes mellitus; prognosis; revascularization