Abstract

Objective

This study assessed the association between HbA1c level measured 2 years after percutaneous coronary intervention (PCI) and long-term clinical outcomes in type 2 diabetes mellitus combined with acute coronary syndrome (ACS) who underwent PCI.

Methods

This prospective observational study analyzed 2877 ACS patients with type 2 diabetes mellitus whose baseline HbA1c ≥ 7.0% and underwent PCI. All patients were divided into 6 groups according to the HbA1c level at 2 years after PCI. The clinical outcome was major adverse cardiovascular events (MACEs), defined as all-cause death, all myocardial infarction, any revascularization, congestive heart failure, ischemic stroke. The median follow-up duration was 4.1 years.

Results

All 2877 patients were divided into 6 groups: 2-year after PCI HbA1c < 6.0% (n = 219), 6.0–6.5% (n = 348), 6.5–7.0% (n = 882), 7.0–7.5% (n = 567), 7.5–8.0% (n = 441), ≥8.0% (n = 420). The 5-year incidence rate of MACEs in HbA1c <6.0% and 6.0–6.5% groups were similar to 7.5–8.0% and ≥8.0% groups, which were significantly higher than in 6.5–7.0% and 7.0–7.5% groups (p = .044). The cumulative incidence rate of MACEs significantly differed among the groups (p = .046). Multivariate Cox regression analysis revealed a U-shaped relationship between 2-year HbA1c level after PCI and risk of MACEs. 2-year HbA1c <6.5% after PCI was an independent risk factor for MACEs in type 2 diabetes mellitus combined with ACS who underwent PCI (p < .001).

Conclusions

The findings indicated an increased risk of MACEs by strict glycemic control after PCI (2-year HbA1c < 6.5% after PCI) in type 2 diabetes mellitus combined with ACS who underwent PCI.

中文翻译：

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2型糖尿病合并急性冠脉综合征患者经皮冠状动脉介入治疗后严格控制血糖（HbA1c < 6.5%，2年）增加心血管不良事件风险：5年随访研究

摘要

客观的

本研究评估了经皮冠状动脉介入治疗 (PCI) 后 2 年测量的 HbA1c 水平与接受 PCI 的 2 型糖尿病合并急性冠状动脉综合征 (ACS) 的长期临床结果之间的关联。

方法

这项前瞻性观察性研究分析了 2877 名基线 HbA1c ≥ 7.0% 并接受 PCI 的 2 型糖尿病 ACS 患者。根据PCI术后2年HbA1c水平将所有患者分为6组。临床结果是主要不良心血管事件（MACE），定义为全因死亡、所有心肌梗死、任何血运重建、充血性心力衰竭、缺血性中风。中位随访时间为 4.1 年。

结果

所有 2877 名患者分为 6 组：PCI 后 2 年 HbA1c < 6.0% ( n  = 219)、6.0–6.5% ( n  = 348)、6.5–7.0% ( n  = 882)、7.0–7.5% ( n  = 567), 7.5–8.0% ( n  = 441), ≥8.0% ( n  = 420)。HbA1c <6.0% 和 6.0-6.5% 组 MACE 的 5 年发生率与 7.5-8.0% 和 ≥8.0% 组相似，显着高于 6.5-7.0% 和 7.0-7.5% 组（p  = .044)。MACEs的累积发病率在各组之间存在显着差异（p = .046)。多变量 Cox 回归分析显示 PCI 后 2 年 HbA1c 水平与 MACE 风险之间存在 U 型关系。PCI 后 2 年 HbA1c <6.5% 是接受 PCI 的 2 型糖尿病合并 ACS 患者发生 MACE 的独立危险因素（p <  .001）。

结论

研究结果表明，在接受 PCI 的 2 型糖尿病合并 ACS 患者 PCI 后严格控制血糖（PCI 后 2 年 HbA1c < 6.5%）会增加 MACE 的风险。