Yeungnam University College of Medicine, Daegu, Korea.
Cardiovascular Division, Yeungnam University Medical Center, Daegu, Korea.
Korean J Intern Med. 2021 Nov;36(6):1365-1376. doi: 10.3904/kjim.2020.694. Epub 2021 Oct 14.
BACKGROUND/AIMS: The clinical benefit of strict blood glucose-lowering therapy for patients with coronary artery disease (CAD) is still debated. We aimed to evaluate the long-term outcomes of patients with diabetes who underwent percutaneous coronary intervention (PCI), according to the mean hemoglobin A1c (HbA1c) level after PCI.
We evaluated 675 diabetes patients with CAD treated with PCI. We categorized the study population into three groups based on the mean observed HbA1c levels during the follow-up duration, as follows: aggressive control (AC) group (HbA1c level < 6.5%, n = 148), moderate control (MC) group (HbA1c level ≥ 6.5% and < 7.0%, n = 138), and uncontrolled (UC) group (HbA1c level ≥ 7.0%, n = 389). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), defined as cardiac death, myocardial infarction, repeat target vessel revascularization, and stroke.
The mean HbA1c level of the AC group was significantly lower than that of the MC and UC groups (6.04% ± 0.36% vs. 6.74% ± 0.14% vs. 8.39% ± 1.20%, p < 0.001). The incidence of MACCEs was significantly lower in the AC group than in the MC and UC groups (16.0% vs. 24.3% vs. 26.3%, p = 0.010), mostly driven by the incidence of stroke (4.4% vs. 14.0% vs. 11.4%, p = 0.013). Multivariate Cox regression analysis showed that only the AC group was associated with a reduced rate of MACCEs (hazard ratio, 0.499; 95% confidence interval, 0.316 to 0.786; p = 0.004) compared with the UC group.
Our study showed that intensive glycemic control (HbA1c level < 6.5%) is associated with improved clinical outcomes after PCI in patients with diabetes.
背景/目的：对于患有冠状动脉疾病（CAD）的患者，严格控制血糖治疗的临床获益仍存在争议。我们旨在评估接受经皮冠状动脉介入治疗（PCI）的糖尿病患者的长期预后，根据 PCI 后平均血红蛋白 A1c（HbA1c）水平进行评估。
我们评估了 675 名接受 PCI 治疗的合并 CAD 的糖尿病患者。我们根据随访期间观察到的平均 HbA1c 水平将研究人群分为三组：积极控制（AC）组（HbA1c 水平 < 6.5%，n = 148）、中度控制（MC）组（HbA1c 水平≥6.5%且<7.0%，n = 138）和未控制（UC）组（HbA1c 水平≥7.0%，n = 389）。主要终点是主要不良心脑血管事件（MACCE），定义为心脏死亡、心肌梗死、靶血管再次血运重建和卒中。
AC 组的平均 HbA1c 水平明显低于 MC 组和 UC 组（6.04%±0.36% vs. 6.74%±0.14% vs. 8.39%±1.20%，p<0.001）。AC 组的 MACCE 发生率明显低于 MC 组和 UC 组（16.0% vs. 24.3% vs. 26.3%，p=0.010），主要是由卒中发生率降低所致（4.4% vs. 14.0% vs. 11.4%，p=0.013）。多变量 Cox 回归分析显示，仅 AC 组与降低 MACCE 发生率相关（风险比，0.499；95%置信区间，0.316 至 0.786；p=0.004），与 UC 组相比。
我们的研究表明，在糖尿病患者中，强化血糖控制（HbA1c 水平<6.5%）与 PCI 后临床结局改善相关。
