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KMID : 0927720100110040315
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Korean Clinical Diabetes
2010 Volume.11 No. 4 p.315 ~ p.323
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Glycemic Control during the Post-PTCA Period Impacts the Progression of Atherosclerosis as Determined through Follow-up Angiography of Patients with Type 2 Diabetes
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Shim Woo-Ho
Lee Eun-Hae
Lee Young-Mi
Kim Hye-Won
Kim Soon-Ae
Bum Sun-Hee
Kim Eun-Sook
Cho Min-Ho
Park Jong-Suk
Ahn Chul-Woo
Cha Bong-Soo
Kim Kyung-Rae
Lee Hyun-Chul
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Abstract
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Background: Several studies have reported that HbA1c level is not a predictor of major adverse cardiovascular events (MACE). We investigated the effects of different degrees of glycemic control to address the need for additional percutaneous transluminal coronary angioplasty (PTCA) as determined by follow-up angiography.
Methods: From a group of 887 diabetes patients who received a successful balloon angioplasty or drug eluting
stent implantation, 232 patients who underwent a nine-month angiographic follow-up were enrolled in the study. Body mass index, blood pressure, ejection fraction, HbA1c, lipid profile, cystatin C level, medication list, and angiographic findings were serially reviewed from the initial intervention to the follow-up angiography.
Results: Sixty-four patients received additional PTCA for a newly developed coronary lesion or restenosis of
the previous intervention site, while there was no need for intervention in 168 patients. The only differences in anthropometric or biochemical parameters between the two groups were baseline HbA1c level (7.36% vs. 7.76%, P = 0.041), follow-up HbA1c (7.14% vs. 7.53%, P = 0.02) and mean HbA1c (7.25% vs. 7.64%, P = 0.012). Multiple linear regression identified poor glycemic control, represented by a higher mean HbA1c, to be an independent risk factor for predicting repeated PTCA (OR 1.606, 95% CI 1.07-2.42, P = 0.023). The measurement of HbA1c quartile showed that strict glycemic control (HbA1c 6.11 ± 0.29%) can reduce the risk of target lesion restenosis and the need for repeated PTCA.
Conclusions: Glycemic control during the post-PTCA period is an independent risk factor for predicting the
need for additional PTCA.
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KEYWORD
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Diabetes mellitus, Coronary disease, Hemoglobin A1c
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