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J Am Coll Cardiol, 2004; 43:8-14, doi:10.1016/j.jacc.2003.06.019
© 2004 by the American College of Cardiology Foundation
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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{dagger}, John A. House, MS*, Simon R. Dixon, MBChB{dagger}, Steven C. Ajluni, MD, FACC{dagger}, William H. Devlin, MD, FACC{dagger}, Gerald C. Timmis, MD, FACC{dagger}, Mamtha Balasubramaniam, MS{dagger} and William W. O'Neill, MD, FACC{dagger}

* Division of Cardiology and Biostatistics, Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri, USA
{dagger} 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.

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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