| BackgroundsPercutaneous coronary intervention(PCI)is one of the most important treatments for coronary heart disease(CHD).ISR after PCI seriously influences the prognosis of patients.Compared with non-diabetes patients,patients with type 2 diabetes mellitus(T2DM)have more extensive coronary lesions,more atherosclerotic plaque burden,higher incidence of ISR after PCI,and worse clinical prognosis.Glycosylated hemoglobin(HbA1c)is an essential indicator for assessing glycemic control in patients with diabetes.However,the American Diabetes Association noted that HbA1c does not provide a measure of glucose excursion.Some diseases,such as hemolytic anemia,can influence the detection of HbA1c value.In recent years,clinicians have increasingly attached importance to glycemic variability(GV)in glycemic management in patients with diabetes.GV is usually defined by the measurement of fluctuations of glucose or other related parameters of glucose homeostasis over a given interval of time,also known as glucose excursion.This description covers two predominant categories of measurements:short-term GV and long-term GV.Previous studies showed that GV was related to the progression of coronary atherosclerosis and the degree of coronary artery disease in patients with diabetes.The incidence of ISR is a long-term chronic process.Understanding the impact of long-term GV on ISR after PCI in CHD patients with T2DM will facilitate early prevention and improve outcomes.ObjectiveThis study aimed to explore the correlation between long-term GV and ISR after PCI in CHD patients with T2DM.MethodsA total of 326 T2DM patients who underwent PCI from September 2017 to March 2021 in the First Affiliated Hospital of Zhengzhou University were included.According to the results of six months to 1-year follow-up coronary angiography,they were divided into ISR group and non-ISR group,with 31 patients and 295 patients,respectively.The general clinical,biochemical data,and echocardiographic data were collected.The coronary artery lesion scope and stent length,stent diameter,and stent counts were also recorded.HbA1c was measured quarterly during the baseline and follow-up period.Then the variability of HbA1c was calculated,expressed as coefficient of variation(HbA1c-CV),standard deviation(HbA1c-SD),and standard deviation adjusted for the number of HbA1c assessments(HbA1c-Adj SD)to represent long-term GV.Multivariate Cox regression models adjusting for confounders were used to analyze the association between long-term GV and ISR.Results1.Baseline characteristicsPatients in ISR group had higher cystatin C level[1.05(0.94,1.23)vs 0.98(0.84,1.13),P=0.044].Less use of calcium-channel blocker[1(3.2)vs 114(38.6),P<0.001]and oral hypoglycemic agent[24(77.4)vs 269(91.2),P=0.025]in subjects with ISR group.Moreover,Insulin was more frequently used[13(41.9)vs 69(23.4),P=0.041]and less history of stroke[3(9.7)vs 139(47.1),P<0.001]in subjects in ISR group.For drinking status,there were statistical differences between patients in abstainer group and those in never,current drinking group(P=0.005,P=0.009).However,the differences in other baseline data were not significant(all P>0.05).2.Procedural characteristicsMore stent counts in ISR group[3.00(2.00,4.00)vs 2.00(1.00,3.00),P=0.002].There were no statistically significant differences in other procedural characteristics(all P>0.05).3.Univariate Cox regression model analysisHbA1c variability was associated with the risk of ISR.HR(per 1-SD increment)of HbA1c-CV,HbA1c-SD,HbA1c-Adj SD were 1.47[95%CI(1.12-1.93)],1.58[95%CI(1.23-2.04)],1.56[95%CI(1.21-2.03)],respectively.4.Multivariate Cox regression models analysisIncreased HbA1c variability was independently associated with elevated risk of I SR after sequentially adjusting for multiple confounders.HR(per 1-SD increment)of HbA1c-CV,HbA1c-SD,HbA1c-Adj SD were 1.73[95%CI(1.14-2.62)],1.77[95%CI(1.17-2.68)],1.73[95%CI(1.14-2.61)],respectively.5.Subgroup analysesComparing the results of the analysis of the two groups in the eight subgroups revealed that in the subgroup with preoperative HbA1c(HbA1c<8%,HbA1c≥ 8%),HbA1c variability was a risk factor for the development of ISR in both groups,HR(per 1%increment)of HbA1c-CV were 2.34[95%CI(1.92-2.85)]and 1.45[95%CI(1.15-1.82)].Moreover,a similar finding in the subgroup with anterior descending artery disease or not:HR(per 1-SD increment)of HbA1c-CV were 2.33[95%CI(1.264.31)],1.77[95%CI(1.17-2.68)].However,HbA1c variability was independently associated with the incidence of ISR only in the following subgroups:female,age ≥60 years,diabetes duration≤5 years,current smoking,non-use of insulin,and cystatin C≥0.98 mg/L.HR(per 1-SD increment)of HbA1c-CV were 5.85[95%CI(3.09-11.09)],2.57[95%CI(1.40-4.73)],2.62[95%CI(1.41-4.88)],2.63[95%CI(1.165.96)],2.47[95%CI(1.40-4.36)],1.95[95%CI(1.13-3.38)],respectively.In addition,there was no significant interaction term between these grouping variables and HbA1c-CV(all P for interaction>0.05).Assessing HbA1c variability by HbA1c-SD or HbA1c-Adj SD yielded similar findings.ConclusionsIncreased long-term GV was independently associated with an elevated risk of incident ISR after PCI in CHD patients with T2DM.Controlling blood glucose at the appropriate level and maintaining stability might optimize the management of CHD patients with T2DM after PCI and reduce ISR incidence. |
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