Department of Clinical Science and Education, Karolinska Institutet, Unit of Cardiology, Södersjukhuset, Stockholm, Sweden.
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
J Am Coll Cardiol. 2024 Jul 16;84(3):260-272. doi: 10.1016/j.jacc.2024.04.012. Epub 2024 May 14.
The impact of glycemic control in the risk of stent failure in subjects with type 2 diabetes (T2D) is currently unknown.
This study sought to study whether poor glycemic control is associated with a higher risk of stent failure in subjects with T2D.
This observational study included all patients in Sweden with T2D who underwent implantation of second-generation drug-eluting stents (DES) during 2010 to 2020. The exposure variable was the updated mean of glycated hemoglobin (HbA). Individuals were stratified by glycemic control, with HbA 6.1% to 7.0% (43-53 mmol/mol) as the reference group. The primary endpoint was the occurrence of stent failure (in-stent restenosis and stent thrombosis). The main result was analyzed in a complete cases model. Sensitivity analyses were performed for missing data and a model with death as a competing risk.
The study population consisted of 52,457 individuals (70,453 DES). The number of complete cases was 24,411 (29,029 DES). The median follow-up was 6.4 years. The fully adjusted HR was 1.10 (95% CI: 0.80-1.52) for HbA of ≤5.5% (≤37 mmol/mol), 1.02 (95% CI: 0.85-1.23) for HbA of 5.6% to 6.0% (38-42 mmol/mol), 1.25 (95% CI: 1.11-1.41) for HbA of 7.1% to 8.0% (54-64 mmol/mol), 1.30 (95% CI: 1.13-1.51) for HbA of 8.1% to 9.0% (65-75 mmol/mol), 1.46 (95% CI: 1.21-1.76) for HbA of 9.1% to 10.0% (76-86 mmol/mol), and 1.33 (95% CI: 1.06-1.66) for HbA of ≥10.1% (≥87 mmol/mol). Sensitivity analyses did not change the main result.
We found a significant association between poor glycemic control and a higher risk of stent failure driven by in-stent restenosis.
目前尚不清楚血糖控制对 2 型糖尿病（T2D）患者支架失败风险的影响。
本研究旨在探讨血糖控制不佳是否与 T2D 患者支架失败风险增加相关。
本观察性研究纳入了 2010 年至 2020 年期间在瑞典接受第二代药物洗脱支架（DES）植入的所有 T2D 患者。暴露变量为糖化血红蛋白（HbA）的更新平均值。个体按血糖控制分层，HbA 为 6.1%至 7.0%（43-53mmol/mol）作为参考组。主要终点为支架失败（支架内再狭窄和支架内血栓形成）的发生。主要结果在完整病例模型中进行分析。对缺失数据和以死亡为竞争风险的模型进行敏感性分析。
研究人群包括 52457 名患者（70453 枚 DES）。完整病例数为 24411 例（29029 枚 DES）。中位随访时间为 6.4 年。完全调整后的 HR 为 HbA≤5.5%（≤37mmol/mol）为 1.10（95%CI：0.80-1.52），HbA 为 5.6%至 6.0%（38-42mmol/mol）为 1.02（95%CI：0.85-1.23），HbA 为 7.1%至 8.0%（54-64mmol/mol）为 1.25（95%CI：1.11-1.41），HbA 为 8.1%至 9.0%（65-75mmol/mol）为 1.30（95%CI：1.13-1.51），HbA 为 9.1%至 10.0%（76-86mmol/mol）为 1.46（95%CI：1.21-1.76），HbA≥10.1%（≥87mmol/mol）为 1.33（95%CI：1.06-1.66）。敏感性分析并未改变主要结果。
我们发现血糖控制不佳与支架内再狭窄驱动的支架失败风险增加之间存在显著关联。
