Role of glycemic control in elective percutaneous coronary interventions in patients with type 2 diabetes

Abstract

Aim. To assess the association of glycemic control (achievement of an individual target glycated hemoglobin level) with the outcomes of elective percutaneous coronary interventions in patients with type 2 diabetes (T2D).Material and methods. This cohort observational study included 74 patients with a median age of 61 (57; 64) years. There were 49% of men with a previously established T2D, who had indications for elective primary percutaneous coronary intervention (PCI) for stable coronary artery disease. At inclusion in the study and after 1 month, the concentration of fasting blood glucose, glycated hemoglobin (HbA1c), fructosamine, and serum creatinine were determined. Plasma glucose levels were determined using the hexokinase method. HbA1c level was determined by immunoturbidimetry on a Konelab 30i chemistry analyzer. The concentration of fructosamine was determined by the kinetic colorimetric assay on a Konelab 30i chemistry analyzer. Statistical processing was carried out using the Statistica 10.0 program from StatSoft, Inc. (USA).Results. At the time of enrollment, 31% of participants had not achieved the target glycated hemoglobin level against the background of nonoptimal hypoglycemic therapy in most cases. A total of 18 (25%) following adverse cardiovascular events were registered within 12 months after PCI: 11 (15%) patients developed acute coronary syndrome; among them, 6 (8%) patients had stent restenosis according to coronary angiography, 4 (6%) patients — progression of atherosclerosis, which required repeated PCI with stenting of another vessel, 2 (3%) patients — cerebrovascular accident, and 3 (4%) patients were hospitalized due to de compensated heart failure. According to multivariate logistic regression, only the HbA1c level was a predictor of adverse outcomes during the year after PCI — a 1% increase in HbA1c level increased the risk of adverse outcomes by 1,79 times (odds ratio, 1,79, 95% confidence interval, 1,06-3,02, p=0,028). Poor glycemic control 1 month before PCI increased the risk of cardiovascular events by 4,04 times over the next year, while non-target HbA1c level immediately before PCI increased the risk of adverse outcomes by 4,7 times, and 5 months after PCI, by 7,34 times.Conclusion. The significance of non-target glycated hemoglobin level for adverse outcomes during the year after elective PCI against the background of T2D was established with an increase in the negative effect as long-term (after myocardial revascularization) maintenance of poor glycemic control.

Keywords

• coronary artery disease
• stable angina
• atherosclerosis
• myocardial revascularization
• type 2 diabetes
• hyperglycemia
• glycemic control
• adverse outcomes
• glycated hemoglobin
• fructosamine