Santos-Pardo I, Andersson Franko M, Lagerqvist B, Ritsinger V, Eliasson B, Witt N, Norhammar A, Nyström T. Glycemic Control and Coronary Stent Failure in Patients With Type 2 Diabetes Mellitus.
J Am Coll Cardiol 2024;
84:260-272. [PMID:
38752901 DOI:
10.1016/j.jacc.2024.04.012]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND
The impact of glycemic control in the risk of stent failure in subjects with type 2 diabetes (T2D) is currently unknown.
OBJECTIVES
This study sought to study whether poor glycemic control is associated with a higher risk of stent failure in subjects with T2D.
METHODS
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 (HbA1c). Individuals were stratified by glycemic control, with HbA1c 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.
RESULTS
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 HbA1c of ≤5.5% (≤37 mmol/mol), 1.02 (95% CI: 0.85-1.23) for HbA1c of 5.6% to 6.0% (38-42 mmol/mol), 1.25 (95% CI: 1.11-1.41) for HbA1c of 7.1% to 8.0% (54-64 mmol/mol), 1.30 (95% CI: 1.13-1.51) for HbA1c of 8.1% to 9.0% (65-75 mmol/mol), 1.46 (95% CI: 1.21-1.76) for HbA1c of 9.1% to 10.0% (76-86 mmol/mol), and 1.33 (95% CI: 1.06-1.66) for HbA1c of ≥10.1% (≥87 mmol/mol). Sensitivity analyses did not change the main result.
CONCLUSIONS
We found a significant association between poor glycemic control and a higher risk of stent failure driven by in-stent restenosis.
Collapse