C ardiovascular disease is the major cause of mortality in patients with type 2 diabetes mellitus.1 Although intensive therapy to lower glucose has consistently been reported to reduce microvascular complications of type 2 diabetes mellitus, 2,3 whether intensive glycemic control reduces macrovascular complications and improves clinical outcomes remains controversial. 4,5 Limited data are available regarding the effect of intensive glycemic control for secondary prevention in patients with established cardiovascular disease, especially in those undergoing percutaneous coronary intervention (PCI). The association between baseline glycosylated hemoglobin A (HbA1c) at the time of PCI and clinical outcomes among diabetic patients was reported in a few studies with conflicting results. 6,7 Moreover, it is not known if glycemic control after PCI can improve cardiovascular outcomes, which is a more important issue than glycemic status at the time of PCI. Because diabetic patients account for more than a quarter of all patients undergoing PCI and have worse outcomes compared with nondiabetic patients, 8,9 determining the optimal strategy for glycemic control in these patients after PCI has substantial clinical implications. Therefore, we investigated the association between glycemic status as estimated by HbA1c measured 2 years after PCI and long-term cardiovascular outcomes in type 2 diabetic patients undergoing PCI using drug-eluting stents (DES).Background-Data on the association between glycemic control after percutaneous coronary intervention and clinical outcomes are limited and controversial in diabetic patients. Methods and Results-We studied 980 patients with type 2 diabetes mellitus undergoing percutaneous coronary intervention using drug-eluting stents. Based on 2-year glycosylated hemoglobin A (HbA1c) levels, we divided patients into 2 groups of HbA1c<7.0 (n=489) and HbA1c≥7.0 (n=491). Propensity score-matched analysis was performed in 322 pairs. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of cardiac death, myocardial infarction, repeat revascularization, or stroke. Median follow-up duration was 5.4 years. The 7-year incidence of MACCE was lower in the HbA1c<7.0 group than in the HbA1c≥7.0 group (26.9% versus 40.3%; adjusted hazard ratio, 0.75; 95% confidence interval, 0.57-0.98; P=0.03). After propensity score matching, the 7-year incidence of MACCE was still lower in the HbA1c<7.0 group than in the HbA1c≥7.0 group (27.5% versus 37.4%; hazard ratio, 0.71; 95% confidence interval, 0.52-0.97; P=0.03), mainly because of a reduction in repeat revascularization (19.9% versus 29.5%; hazard ratio, 0.66; 95% confidence interval, 0.47-0.93; P=0.02). In subgroup analyses, the benefit of glycemic control for MACCE was more prominent in patients with residual SYNTAX score (Synergy Between PCI With Taxus and Cardiac Surgery) >4 than in those with the residual SYNTAX score ≤4 (P interaction =0.004). Conclusions-HbA1c<7.0 measured 2 years after percutaneous cor...
Background Whether use of high‐intensity statins is more important than achieving low‐density lipoprotein cholesterol ( LDL ‐C) target remains controversial in patients with coronary artery disease. We sought to investigate the association between statin intensity and long‐term clinical outcomes in patients achieving treatment target for LDL ‐C after percutaneous coronary intervention. Methods and Results Between February 2003 and December 2014, 1746 patients who underwent percutaneous coronary intervention and achieved treatment target for LDL ‐C (<70 mg/dL or >50% reduction from baseline level) were studied. We classified patients into 2 groups according to an intensity of statin prescribed after index percutaneous coronary intervention: high‐intensity statin group (atorvastatin 40 or 80 mg, and rosuvastatin 20 mg, 372 patients) and non‐high‐intensity statin group (the other statin treatment, 1374 patients). The primary outcome was a composite of cardiac death, myocardial infarction, or stroke. Difference in time‐averaged LDL ‐C during follow‐up was significant, but small, between the high‐intensity statin group and non‐high‐intensity statin group (59±13 versus 61±12 mg/dL; P =0.04). At 5 years, patients receiving high‐intensity statins had a significantly lower incidence of the primary outcome than those treated with non‐high‐intensity statins (4.1% versus 9.9%; hazard ratio, 0.42; 95% confidence interval, 0.23–0.79; P <0.01). Results were consistent after propensity‐score matching (4.2% versus 11.2%; hazard ratio, 0.36; 95% confidence interval, 0.19–0.69; P <0.01) and across various subgroups. Conclusions Among patients achieving treatment target for LDL ‐C after percutaneous coronary intervention, high‐intensity statins were associated with a lower risk of major adverse cardiovascular events than non‐high‐intensity statins despite a small difference in achieved LDL ‐C level.
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