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. Methods and 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 ( P interaction =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.