Department of Cardiology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, People's Republic of China.
Institute of Cardiovascular Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, People's Republic of China.
Cardiovasc Diabetol. 2020 Sep 4;19(1):133. doi: 10.1186/s12933-020-01111-7.
Patients with type 2 diabetes are under substantially higher risk of in-stent restenosis (ISR) after coronary stent implantation. We sought to investigate whether visit-to-visit HbA variability is a potential predictor of ISR in diabetic patients after stent implantation.
We consecutively enrolled type 2 diabetic patients who underwent successful elective percutaneous coronary intervention and performed follow-up coronary angiography after around 12 months. The incidence of ISR and its relationship with visit-to-visit HbA variability, expressed as coefficient of variation (CV), standard deviation (SD) and variability independent of the mean (VIM), were studied. Multivariable Cox proportional hazards models were constructed to analyze the predictive value of HbA variability for ISR.
From September 2014 to July 2018 in Ruijin Hospital, a total of 420 diabetic patients (688 lesions) after stent implantation were included in the final analysis. During a mean follow-up of 12.8 ± 1.3 months, the incidence of ISR was 8.6%, which was significantly increased in patients with higher CV of HbA (P = 0.001). The mean diameter stenosis (DS), net luminal loss and net luminal gain were 22.9 ± 16.8%, 0.42 ± 0.88 mm and 1.66 ± 0.83 mm, respectively. Greater DS was observed in subjects with higher tertiles of CV of HbA (P < 0.001), and this trend was more prominent in patients with optimal glycemic control (HbA ≤ 7%) in the baseline. In multivariate analysis, HbA variability was independently associated with incidence of ISR after adjustment for traditional risk factors and mean HbA (HR: 3.00 [95% CI 1.14-7.92] for highest vs. lowest tertile). Inclusion of CV of HbA led to a better risk stratification accuracy. Assessing HbA variability by SD or VIM yielded similar findings.
This study suggests that visit-to-visit HbA variability is an independent predictor of incidence of ISR in patients with type 2 diabetes after stent implantation. Trial registration NCT02089360: NCT.
2 型糖尿病患者在冠状动脉支架植入术后发生支架内再狭窄（ISR）的风险显著增加。我们旨在探讨支架植入术后患者的 HbA 变异是否是 ISR 的潜在预测因素。
我们连续纳入了 2014 年 9 月至 2018 年 7 月在瑞金医院成功接受择期经皮冠状动脉介入治疗并在大约 12 个月后进行随访冠状动脉造影的 2 型糖尿病患者。研究了 ISR 的发生率及其与 HbA 变异的关系，HbA 变异以变异系数（CV）、标准差（SD）和均值独立变异（VIM）表示。构建多变量 Cox 比例风险模型分析 HbA 变异对 ISR 的预测价值。
在瑞金医院，共纳入了 420 名支架植入术后的糖尿病患者（688 处病变），最终进行了分析。在平均 12.8±1.3 个月的随访期间，ISR 的发生率为 8.6%，HbA 的 CV 较高的患者发生率显著增加（P=0.001）。平均直径狭窄（DS）、净管腔丢失和净管腔获得分别为 22.9±16.8%、0.42±0.88mm 和 1.66±0.83mm。CV 较高的患者中，DS 较大（P<0.001），且在基线时血糖控制较好（HbA≤7%）的患者中，这一趋势更为明显。在多变量分析中，在调整了传统危险因素和平均 HbA 后，HbA 变异与 ISR 的发生独立相关（最高 vs. 最低三分位 HR：3.00[95%CI 1.14-7.92]）。纳入 HbA 的 CV 可提高风险分层的准确性。使用 SD 或 VIM 评估 HbA 变异可得出类似的结果。
本研究表明，支架植入术后患者的 HbA 变异是 2 型糖尿病患者发生 ISR 的独立预测因素。试验注册 NCT02089360：NCT.
