CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Optimal glycemic control is associated with a lower rate of target vessel revascularization in treated type II diabetic patients undergoing elective percutaneous coronary intervention
Roberto A. Corpus, MD*,*,
Peter B. George, MD ,
John A. House, MS*,
Simon R. Dixon, MBChB,
Steven C. Ajluni, MD, FACC,
William H. Devlin, MD, FACC,
Gerald C. Timmis, MD, FACC,
Mamtha Balasubramaniam, MS and
William W. O'Neill, MD, FACC
* Division of Cardiology and Biostatistics, Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri, USA
Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
Manuscript received April 18, 2003;
revised manuscript received June 23, 2003,
accepted June 30, 2003.
* Reprint requests and correspondence: Dr. Roberto A. Corpus, Assistant Professor, Department of Cardiology, University of Missouri-Kansas City, Mid America Heart Institute, 4401 Wornall Road, Kansas City, Missouri 64111, USA.
rjcorpus{at}yahoo.com
OBJECTIVES: We examined the association between glycemic control determined by preprocedural hemoglobin A1c (A1c) and the incidence of target vessel revascularization (TVR) in diabetic patients undergoing elective percutaneous coronary intervention (PCI).
BACKGROUND: Patients with diabetes mellitus (DM) have increased rates of restenosis and a worse clinical outcome after PCI than patients without DM.
METHODS: A total of 239 patients (60 without DM and 179 with DM) were enrolled in this study. Optimal glycemic control was defined as A1c  7%, and suboptimal control was defined as A1c >7%. Follow-up was performed at six and 12 months after the index intervention.
RESULTS: Diabetic patients with optimal glycemic control had a rate of 12-month TVR similar to that of nondiabetic patients (15% vs. 18%, p = NS). Diabetic patients with A1c >7% had a significantly higher rate of TVR than those with A1c <7% (34% vs. 15%, p = 0.02). In a multiple logistic regression analysis, A1c >7% was a significant independent predictor of TVR (odds ratio 2.87, 95% confidence interval 1.13 to 7.24; p = 0.03). Optimal glycemic control was associated with a lower rate of cardiac rehospitalization (15% vs. 31%, p = 0.03) and recurrent angina (13% vs. 37%, p = 0.002) at 12-month follow-up.
CONCLUSIONS: In diabetic patients undergoing elective PCI, optimal glycemic control (A1c 7%) is associated with a lower rate of TVR, cardiac rehospitalization, and recurrent angina. These data suggest that aggressive treatment of DM to achieve A1c 7% is beneficial in improving the clinical outcome after PCI.
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Abbreviations and Acronyms
| | A1c | = hemoglobin A1c | | CABG | = coronary artery bypass graft surgery | | CAD | = coronary artery disease | | CHF | = congestive heart failure | | MI | = myocardial infarction | | MLD | = minimum luminal diameter | | PCI | = percutaneous coronary intervention | | PTCA | = percutaneous transluminal coronary angioplasty | | TVR | = target vessel revascularization |
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