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

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 hemoglob...

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Autores principales:	Jaekyung Bae, Ji-Hyung Yoon, Jung-Hee Lee, Jong-Ho Nam, Chan-Hee Lee, Jang-Won Son, Ung Kim, Jong-Seon Park, Dong-Gu Shin
Formato:	article
Lenguaje:	EN
Publicado:	The Korean Association of Internal Medicine 2021
Materias:	coronary artery disease diabetes mellitus percutaneous coronary intervention glycated hemoglobin a treatment outcome Medicine R
Acceso en línea:	https://doaj.org/article/7c92977c81b74294bc69ddc15917eecf
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spelling	oai:doaj.org-article:7c92977c81b74294bc69ddc15917eecf2021-11-08T00:59:06ZLong-term effects of the mean hemoglobin A1c levels after percutaneous coronary intervention in patients with diabetes1226-33032005-664810.3904/kjim.2020.694https://doaj.org/article/7c92977c81b74294bc69ddc15917eecf2021-11-01T00:00:00Zhttp://www.kjim.org/upload/pdf/kjim-2020-694.pdfhttps://doaj.org/toc/1226-3303https://doaj.org/toc/2005-6648Background/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.Jaekyung BaeJi-Hyung YoonJung-Hee LeeJong-Ho NamChan-Hee LeeJang-Won SonUng KimJong-Seon ParkDong-Gu ShinThe Korean Association of Internal Medicinearticlecoronary artery diseasediabetes mellituspercutaneous coronary interventionglycated hemoglobin atreatment outcomeMedicineRENThe Korean Journal of Internal Medicine, Vol 36, Iss 6, Pp 1365-1376 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	coronary artery disease diabetes mellitus percutaneous coronary intervention glycated hemoglobin a treatment outcome Medicine R
spellingShingle	coronary artery disease diabetes mellitus percutaneous coronary intervention glycated hemoglobin a treatment outcome Medicine R Jaekyung Bae Ji-Hyung Yoon Jung-Hee Lee Jong-Ho Nam Chan-Hee Lee Jang-Won Son Ung Kim Jong-Seon Park Dong-Gu Shin Long-term effects of the mean hemoglobin A1c levels after percutaneous coronary intervention in patients with diabetes
description	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.
format	article
author	Jaekyung Bae Ji-Hyung Yoon Jung-Hee Lee Jong-Ho Nam Chan-Hee Lee Jang-Won Son Ung Kim Jong-Seon Park Dong-Gu Shin
author_facet	Jaekyung Bae Ji-Hyung Yoon Jung-Hee Lee Jong-Ho Nam Chan-Hee Lee Jang-Won Son Ung Kim Jong-Seon Park Dong-Gu Shin
author_sort	Jaekyung Bae
title	Long-term effects of the mean hemoglobin A1c levels after percutaneous coronary intervention in patients with diabetes
title_short	Long-term effects of the mean hemoglobin A1c levels after percutaneous coronary intervention in patients with diabetes
title_full	Long-term effects of the mean hemoglobin A1c levels after percutaneous coronary intervention in patients with diabetes
title_fullStr	Long-term effects of the mean hemoglobin A1c levels after percutaneous coronary intervention in patients with diabetes
title_full_unstemmed	Long-term effects of the mean hemoglobin A1c levels after percutaneous coronary intervention in patients with diabetes
title_sort	long-term effects of the mean hemoglobin a1c levels after percutaneous coronary intervention in patients with diabetes
publisher	The Korean Association of Internal Medicine
publishDate	2021
url	https://doaj.org/article/7c92977c81b74294bc69ddc15917eecf
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Long-term effects of the mean hemoglobin A1c levels after percutaneous coronary intervention in patients with diabetes

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