Clinical Impact of Dysglycemia in Patients with an Acute Myocardial Infarction

Chung, Jong Hak; Park, Yeong-Seon; Seo, Jeong-Eon; Son, Yeseul; Oh, Cheol-Woo; Lee, Chanhee; Nam, Jong-Ho; Lee, Jung‐Hee; Son, Jang‐Won; Kim, Ung; Park, Jong Seon; Won, Kyu-Chang; Shin, Dong‐Gu

doi:10.4093/dmj.2019.0164

Cited by 11 publications

(10 citation statements)

References 13 publications

(12 reference statements)

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“…The association between glycemic control and clinical outcomes after PCI in patients with diabetes has been evaluated. Several studies have suggested that the effect of dysglycemia at the time of admission or before PCI can be related to poor prognosis after PCI in diabetes patients with acute coronary syndrome [13][14][15][16]. However, the glycemic status before PCI cannot reflect the longterm effects of glycemic control because catecholamine surge induced in response to acute coronary events may be associated with dysglycemia.…”

Section: Discussionmentioning

confidence: 99%

Long-term effects of the mean hemoglobin A1c levels after percutaneous coronary intervention in patients with diabetes

Bae

Yoon

Lee

et al. 2021

Korean J Intern Med

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METHODS Study population and data collectionWe investigated the clinical data of 732 diabetes patients with CAD who underwent PCI from January 2010 to December 2013, from the medical database of the Yeungnam University Medical Center PCI registry. After excluding 57 patients (10 patients with in-hospital mortality and 47 patients with no available HbA1c data), a total of 675 patients were included in the final analysis. We categorized the study population into three groups based on the mean observed HbA1c levels during the follow-up period: aggressive control (AC) group (HbA1c level < 6.5%, n = 148), moderate control (MC) group (HbA1c level ≥ 6.5% and < 7.0%, n = 138), and uncontrolled (UC) group (HbA1c level ≥ 7.0%, n = 389). Fig. 1 outlines the selectionBackground/Aims: The clinical benefit of strict blood glucose-lowering therapy for patients with coronary artery disease (CAD) is still debated. We aimed to evaluate the long-term outcomes of patients with diabetes who underwent percutaneous coronary intervention (PCI), according to the mean hemoglobin A1c (HbA1c) level after PCI. Methods: We evaluated 675 diabetes patients with CAD treated with PCI. We categorized the study population into three groups based on the mean observed HbA1c levels during the follow-up duration, as follows: aggressive control (AC) group (HbA1c level < 6.5%, n = 148), moderate control (MC) group (HbA1c level ≥ 6.5% and < 7.0%, n = 138), and uncontrolled (UC) group (HbA1c level ≥ 7.0%, n = 389). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), defined as cardiac death, myocardial infarction, repeat target vessel revascularization, and stroke. Results:The mean HbA1c level of the AC group was significantly lower than that of the MC and UC groups (6.04% ± 0.36% vs. 6.74% ± 0.14% vs. 8.39% ± 1.20%, p < 0.001). The incidence of MACCEs was significantly lower in the AC group than in the MC and UC groups (16.0% vs. 24.3% vs. 26.3%, p = 0.010), mostly driven by the incidence of stroke (4.4% vs. 14.0% vs. 11.4%, p = 0.013). Multivariate Cox regression analysis showed that only the AC group was associated with a reduced rate of MACCEs (hazard ratio, 0.499; 95% confidence interval, 0.316 to 0.786; p = 0.004) compared with the UC group. Conclusions: Our study showed that intensive glycemic control (HbA1c level < 6.5%) is associated with improved clinical outcomes after PCI in patients with diabetes.

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Section: Discussionmentioning

confidence: 99%

Long-term effects of the mean hemoglobin A1c levels after percutaneous coronary intervention in patients with diabetes

Bae

Yoon

Lee

et al. 2021

Korean J Intern Med

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“…Several studies have shown that poor glycemic control after PCI might lead to worse clinical outcomes, including cardiac death, MI, restenosis after PCI, and stroke [ 12 , 13 ]. Hwang et al [ 14 ] reported that good glycemic control after PCI was associated with a reduced rate of major adverse cardiac events, including repeat revascularization.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Glucose Lowering Agents on the Secondary Prevention of Coronary Artery Disease in Patients with Type 2 Diabetes

et al. 2021

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Background: Patients with diabetes have a higher risk of requiring repeated percutaneous coronary intervention (PCI) than non-diabetic patients. We aimed to evaluate and compare the effects of anti-diabetic drugs on the secondary prevention of myocardial infarction among type 2 diabetes mellitus patients. Methods: We analyzed the general health check-up dataset and claims data of the Korean National Health Insurance Service of 199,714 participants (age ≥30 years) who underwent PCIs between 2010 and 2013. Those who underwent additional PCI within 1 year of their first PCI (n=3,325) and those who died within 1 year (n=1,312) were excluded. Patients were classified according to their prescription records for glucose-lowering agents. The primary endpoint was the incidence rate of coronary revascularization. Results: A total of 35,348 patients were included in the study. Metformin significantly decreased the risk of requiring repeat PCI in all patients (adjusted hazard ratio [aHR], 0.77). In obese patients with body mass index (BMI) ≥25 kg/m 2 , patients treated with thiazolidinedione (TZD) exhibited a decreased risk of requiring repeat revascularization than those who were not treated with TZD (aHR, 0.77; 95% confidence interval, 0.63 to 0.95). Patients treated with metformin showed a decreased risk of requiring revascularization regardless of their BMI. Insulin, meglitinide, and alpha-glucosidase inhibitor were associated with increased risk of repeated PCI. Conclusion:The risk of requiring repeat revascularization was lower in diabetic patients treated with metformin and in obese patients treated with TZD. These results suggest that physicians should choose appropriate glucose-lowering agents for the secondary prevention of coronary artery disease.

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“…The association between glycemic control and clinical outcomes after PCI in patients with diabetes has been evaluated. Several studies have suggested that the effect of dysglycemia at the time of admission or before PCI can be related to poor prognosis after PCI in diabetes patients with acute coronary syndrome [13][14][15][16]. However, the glycemic status before PCI cannot re ect the long-term effects of glycemic control because catecholamine surge induced in response to acute coronary events may be associated with dysglycemia.…”

Section: Discussionmentioning

confidence: 99%

Long-term effects of the mean hemoglobin A1c levels after percutaneous coronary intervention in patients with diabetes

Bae

Yoon

Lee

et al. 2020

Preprint

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Background: There is controversy regarding the long-term effect of glycemic control on the clinical outcomes after percutaneous coronary intervention (PCI) in diabetes patients with coronary artery disease (CAD). We aimed to evaluate the long-term outcomes of patients with diabetes who underwent PCI, according to the mean hemoglobin A1c (HbA1c) level after PCI.Methods: We retrospectively evaluated 675 diabetes patients with CAD treated with PCI from 2010 to 2013. We categorized the study population into three groups based on the mean observed HbA1c levels during the follow-up duration, as follows: aggressive control (AC) group (HbA1c level <6.5%, n=148), moderate control (MC) group (HbA1c level ≥6.5% and <7.0%, n=138), and uncontrolled (UC) group (HbA1c level ≥7.0%, n=389). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), defined as cardiac death, myocardial infarction, repeat target vessel revascularization, and stroke. The median follow-up duration was 74.1 (32.6–85.0) months.Results: The mean HbA1c level of the AC group was significantly lower than that of the MC and UC groups (6.04±0.36% vs. 6.74±0.14% vs. 8.39±1.20%, p<0.001). Patients in the AC group were older than those in the MC and UC groups (66.2±10.0 vs. 64.4±11.3 vs. 62.9±10.4 years, p=0.004); however, the other clinical characteristics were similar among the groups. The incidence of MACCEs was significantly lower in the AC group than in the MC and UC groups (16.0% vs. 24.3% vs. 26.3%, p=0.010), mostly driven by the incidence of stroke (4.4% vs. 14.0% vs. 11.0%, p=0.013). Multivariate Cox regression analysis showed that only the AC group was associated with a reduced rate of MACCEs (hazard ratio 0.513, 95% confidence interval 0.326–0.808, p=0.004) compared with the UC group.Conclusion: Our study showed that intensive glycemic control (HbA1c level <6.5%) is associated with improved clinical outcomes after PCI in patients with diabetes.

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Clinical Impact of Dysglycemia in Patients with an Acute Myocardial Infarction

Cited by 11 publications

References 13 publications

Long-term effects of the mean hemoglobin A1c levels after percutaneous coronary intervention in patients with diabetes

Long-term effects of the mean hemoglobin A1c levels after percutaneous coronary intervention in patients with diabetes

The Effects of Glucose Lowering Agents on the Secondary Prevention of Coronary Artery Disease in Patients with Type 2 Diabetes

Long-term effects of the mean hemoglobin A1c levels after percutaneous coronary intervention in patients with diabetes

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