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J Clin Med. 2020;9(8):jcm9082464.

Impact of Intensive Glucose Control in Patients with Diabetes Mellitus Undergoing Percutaneous Coronary Intervention: 3-Year Clinical Outcomes.

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제1저자 박지숙, 한정규 · 교신저자 김효수

소속 (1)
  1. Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Korea.

Abstract

We investigated whether intensive glucose control after percutaneous coronary intervention (PCI) improves clinical outcomes in diabetic patients. From the Grand-DES registry, we analyzed 2576 diabetic patients (median age 66 years, male 65.6%) who underwent PCI and had at least 2 records of HbA1c during the follow-up. Patients were categorized according to the mean HbA1c (≥7% or <7%). Primary outcome was major adverse cardiovascular event (MACE), a composite of cardiac death, non-fatal myocardial infarction, and any revascularization. During a median follow-up of 33.6 months, MACE occurred in 335 (13.0%) patients. Intensive glucose control with follow-up mean HbA1c < 7.0% (42.2%; n = 1087) was not associated with lower risk of MACE, compared to control with mean HbA1c ≥ 7.0% (adjusted hazard ratio [aHR] [95% confidence interval] 1.06 [0.82-1.37], p = 0.672). In subgroup analysis, patients with sustained HbA1c of <7.0% throughout the follow-up were not associated with a lower risk of MACE compared to those with sustained HbA1c of ≥7.0% (aHR 1.15 [0.71-1.89], p = 0.566). More intensive glucose control with mean HbA1c ≤ 6.5% was not associated with lower risk of MACE, compared to loose control with a mean HbA1c ≥ 8.0% (aHR 1.15 [0.71-1.86], p = 0.583). Intensive glucose control after PCI was not associated with better clinical outcomes in diabetic patients undergoing PCI than lenient control.

Keywords

HbA1cdiabetes mellitushyperglycemiapercutaneous coronary intervention

Figures

Figure 1
Figure 1 Study flow. From the Grand-DES registry, a patient-level pooled registry including five Korean multicenter prospective drug-eluting stent registries, a total of 17,286 patients with CAD, who had undergone PCI, were screened for inclusion in this study. After collecting the records of HbA1c level trimonthly after discharge, a total of 2576 patients with DM, who underwent PCI and had at least ≥2 records of HbA1c, were finally included. Patients were classified according to mean HbA1c cut-off value of 7%. CAD = coronary artery disease, DM = diabetes mellitus, PCI = percutaneous coronary intervention.
Figure 2
Figure 2 Temporal changes in HbA1c in the overall and propensity score matched 516 paired populations. The figures represent the temporal changes in HbA1c among the overall (A) and propensity score matched population (B). The blue and red lines represent the mean HbA1c < 7.0 group and mean HbA1c ≥ 7.0 group, respectively. The error bars represent the interquartile range of HbA1c level.
Figure 3
Figure 3 Kaplan–Meier curve for clinical outcomes according to mean HbA1c cut-off of 7.0% in the overall populations. Among the overall population, patients with mean HbA1c ≥ 7% was not associated with a better event-free survival in clinical outcomes compared with those with mean HbA1c < 7%. MACE = major adverse cardiovascular event.
Figure 4
Figure 4 Subgroup analysis of clinical outcomes according to mean HbA1c cut-off of 7.0%. In subgroup analysis, mean HbA1c < 7.0% group showed no significant risk reduction for MACE compared with mean HbA1c ≥ 7.0% group across various subgroups except for those with insulin treatment. For subgroup with insulin treatment, HbA1c < 7.0% group was associated with a higher risk of MACE than HbA1c ≥ 7% group. ACS = acute coronary syndrome, CI = confidence interval, aHR = adjusted hazard ratio, LVEF = left ventricular ejection fraction, MACE = major adverse cardiovascular event, MI = myocardial infarction, PS = propensity score.

그림 출처: PubMed Central 공개 논문 (PMC7465631)

Conflict of interest statement

The authors declare no conflict of interest.

그 밖의 정보
출판 형태
Journal Article
저널
Journal of clinical medicine · ISSN 2077-0383
전자 출판
2020-08-01
연구비
Chong Kun Dang Inc. (Seoul) N/A · Ministry of Health and Welfare in Republic of Korea HI17C2085, HI14C1277
참고문헌
33편