Increased risk of adverse cardiovascular events by strict glycemic control after percutaneous coronary intervention (HbA1c < 6.5% at 2 years) in type 2 diabetes mellitus combined with acute coronary syndrome: a 5-years follow-up study

Abstract

Objective

This study assessed the association between HbA1c level measured 2 years after percutaneous coronary intervention (PCI) and long-term clinical outcomes in type 2 diabetes mellitus combined with acute coronary syndrome (ACS) who underwent PCI.

Methods

This prospective observational study analyzed 2877 ACS patients with type 2 diabetes mellitus whose baseline HbA1c ≥ 7.0% and underwent PCI. All patients were divided into 6 groups according to the HbA1c level at 2 years after PCI. The clinical outcome was major adverse cardiovascular events (MACEs), defined as all-cause death, all myocardial infarction, any revascularization, congestive heart failure, ischemic stroke. The median follow-up duration was 4.1 years.

Results

All 2877 patients were divided into 6 groups: 2-year after PCI HbA1c < 6.0% (n = 219), 6.0–6.5% (n = 348), 6.5–7.0% (n = 882), 7.0–7.5% (n = 567), 7.5–8.0% (n = 441), ≥8.0% (n = 420). The 5-year incidence rate of MACEs in HbA1c <6.0% and 6.0–6.5% groups were similar to 7.5–8.0% and ≥8.0% groups, which were significantly higher than in 6.5–7.0% and 7.0–7.5% groups (p = .044). The cumulative incidence rate of MACEs significantly differed among the groups (p = .046). Multivariate Cox regression analysis revealed a U-shaped relationship between 2-year HbA1c level after PCI and risk of MACEs. 2-year HbA1c <6.5% after PCI was an independent risk factor for MACEs in type 2 diabetes mellitus combined with ACS who underwent PCI (p < .001).

Conclusions

The findings indicated an increased risk of MACEs by strict glycemic control after PCI (2-year HbA1c < 6.5% after PCI) in type 2 diabetes mellitus combined with ACS who underwent PCI.

Keywords:

• Type 2 diabetes mellitus
• HbA1c
• strict glycemic control
• major adverse cardiovascular events
• percutaneous coronary intervention

Transparency

Declaration of funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

TY, PF, JC and XL wrote the manuscript and researched the data. CX and TN contributed to discussion. PF and XF designed the study and reviewed the data and revised the manuscript. All authors have read the final manuscript and approved the data present in it and approved to submit it to your journal. None of the authors have any conflict of interest to report. Neither the entire paper nor any part of its content has been published or has been accepted elsewhere. It is original and not being submitted to any other journal.

Acknowledgements

None stated.

Data availability statement

All data generated or analyzed during this study are included in this article.

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Shengjing Hospital. Written informed consents was obtained from all enrolled MI inpatients.