Association of Diabetic Status and Glycemic Control With Ischemic and Bleeding Outcomes in Patients With Stable Coronary Artery Disease: The 5‐Year CORONOR Registry

BackgroundThe relation between diabetes mellitus, glycemic control, and ischemic and bleeding events is poorly described in outpatients with stable coronary artery disease receiving modern secondary prevention. Methods and ResultsThe multicenter CORONOR (Suivi d'une cohorte de patients Coronari...

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Autores principales:	Gilles Lemesle, Thibaud Meurice, Olivier Tricot, Nicolas Lamblin, Christophe Bauters
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2018
Materias:	diabetes mellitus hemoglobin A1c mortality prognosis stable coronary artery disease Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/bac25e22739e417d8531e29144576919
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spelling	oai:doaj.org-article:bac25e22739e417d8531e291445769192021-11-12T17:01:58ZAssociation of Diabetic Status and Glycemic Control With Ischemic and Bleeding Outcomes in Patients With Stable Coronary Artery Disease: The 5‐Year CORONOR Registry10.1161/JAHA.117.0083542047-9980https://doaj.org/article/bac25e22739e417d8531e291445769192018-05-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.117.008354https://doaj.org/toc/2047-9980BackgroundThe relation between diabetes mellitus, glycemic control, and ischemic and bleeding events is poorly described in outpatients with stable coronary artery disease receiving modern secondary prevention. Methods and ResultsThe multicenter CORONOR (Suivi d'une cohorte de patients Coronariens stables en région Nord‐pas‐de‐Calais) registry enrolled 4184 outpatients with stable coronary artery disease, including 1297 patients (31%) with diabetes mellitus. A recent glycosylated hemoglobin (HbA1c) was available for 1146 diabetic patients, and 48% had HbA1c ≥7%. We analyzed 5‐year ischemic (cardiovascular death, myocardial infarction, and stroke) and bleeding (Bleeding Academic Research Consortium ≥3) outcomes, according to diabetic status and glycemic control. When compared with nondiabetic patients, the ischemic risk was higher in diabetic patients with HbA1c ≥7% (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.25–1.93) but not in diabetic patients with HbA1c <7% (HR, 1.06; 95% CI, 0.83–1.36). Diabetic patients with HbA1c ≥7% were at higher risk than diabetic patients with HbA1c <7% (HR, 1.47; 95% CI, 1.09–1.98). When compared with nondiabetic patients, the bleeding risk was higher in diabetic patients, with HbA1c <7% (HR, 1.66; 95% CI, 1.04–2.67) and in those with HbA1c ≥7% (HR, 1.75; 95% CI, 1.07–2.86). No difference in bleeding risk was observed between diabetic patients with HbA1c ≥7% versus those with HbA1c <7%. Similar results were obtained when adjusted for baseline characteristics. ConclusionsThe 5‐year increased risk of ischemic events in patients with stable coronary artery disease with diabetes mellitus was restricted to those with HbA1c ≥7%. By contrast, the increase in bleeding risk associated with diabetes mellitus was observed in patients with HbA1c ≥7% and in patients with HbA1c <7%. The level of HbA1c should be taken into account for future research and may help physicians to manage prolonged antithrombotic therapies in this high‐risk subgroup.Gilles LemesleThibaud MeuriceOlivier TricotNicolas LamblinChristophe BautersWileyarticlediabetes mellitushemoglobin A1cmortalityprognosisstable coronary artery diseaseDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 7, Iss 10 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	diabetes mellitus hemoglobin A1c mortality prognosis stable coronary artery disease Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	diabetes mellitus hemoglobin A1c mortality prognosis stable coronary artery disease Diseases of the circulatory (Cardiovascular) system RC666-701 Gilles Lemesle Thibaud Meurice Olivier Tricot Nicolas Lamblin Christophe Bauters Association of Diabetic Status and Glycemic Control With Ischemic and Bleeding Outcomes in Patients With Stable Coronary Artery Disease: The 5‐Year CORONOR Registry
description	BackgroundThe relation between diabetes mellitus, glycemic control, and ischemic and bleeding events is poorly described in outpatients with stable coronary artery disease receiving modern secondary prevention. Methods and ResultsThe multicenter CORONOR (Suivi d'une cohorte de patients Coronariens stables en région Nord‐pas‐de‐Calais) registry enrolled 4184 outpatients with stable coronary artery disease, including 1297 patients (31%) with diabetes mellitus. A recent glycosylated hemoglobin (HbA1c) was available for 1146 diabetic patients, and 48% had HbA1c ≥7%. We analyzed 5‐year ischemic (cardiovascular death, myocardial infarction, and stroke) and bleeding (Bleeding Academic Research Consortium ≥3) outcomes, according to diabetic status and glycemic control. When compared with nondiabetic patients, the ischemic risk was higher in diabetic patients with HbA1c ≥7% (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.25–1.93) but not in diabetic patients with HbA1c <7% (HR, 1.06; 95% CI, 0.83–1.36). Diabetic patients with HbA1c ≥7% were at higher risk than diabetic patients with HbA1c <7% (HR, 1.47; 95% CI, 1.09–1.98). When compared with nondiabetic patients, the bleeding risk was higher in diabetic patients, with HbA1c <7% (HR, 1.66; 95% CI, 1.04–2.67) and in those with HbA1c ≥7% (HR, 1.75; 95% CI, 1.07–2.86). No difference in bleeding risk was observed between diabetic patients with HbA1c ≥7% versus those with HbA1c <7%. Similar results were obtained when adjusted for baseline characteristics. ConclusionsThe 5‐year increased risk of ischemic events in patients with stable coronary artery disease with diabetes mellitus was restricted to those with HbA1c ≥7%. By contrast, the increase in bleeding risk associated with diabetes mellitus was observed in patients with HbA1c ≥7% and in patients with HbA1c <7%. The level of HbA1c should be taken into account for future research and may help physicians to manage prolonged antithrombotic therapies in this high‐risk subgroup.
format	article
author	Gilles Lemesle Thibaud Meurice Olivier Tricot Nicolas Lamblin Christophe Bauters
author_facet	Gilles Lemesle Thibaud Meurice Olivier Tricot Nicolas Lamblin Christophe Bauters
author_sort	Gilles Lemesle
title	Association of Diabetic Status and Glycemic Control With Ischemic and Bleeding Outcomes in Patients With Stable Coronary Artery Disease: The 5‐Year CORONOR Registry
title_short	Association of Diabetic Status and Glycemic Control With Ischemic and Bleeding Outcomes in Patients With Stable Coronary Artery Disease: The 5‐Year CORONOR Registry
title_full	Association of Diabetic Status and Glycemic Control With Ischemic and Bleeding Outcomes in Patients With Stable Coronary Artery Disease: The 5‐Year CORONOR Registry
title_fullStr	Association of Diabetic Status and Glycemic Control With Ischemic and Bleeding Outcomes in Patients With Stable Coronary Artery Disease: The 5‐Year CORONOR Registry
title_full_unstemmed	Association of Diabetic Status and Glycemic Control With Ischemic and Bleeding Outcomes in Patients With Stable Coronary Artery Disease: The 5‐Year CORONOR Registry
title_sort	association of diabetic status and glycemic control with ischemic and bleeding outcomes in patients with stable coronary artery disease: the 5‐year coronor registry
publisher	Wiley
publishDate	2018
url	https://doaj.org/article/bac25e22739e417d8531e29144576919
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Association of Diabetic Status and Glycemic Control With Ischemic and Bleeding Outcomes in Patients With Stable Coronary Artery Disease: The 5‐Year CORONOR Registry

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