Glycosylated hemoglobin and outcomes in diabetic patients with acute myocardial infarction after successful revascularization with stent placement: Findings from the Guthrie Health Off-Label Stent (GHOST) investigators

摘要

Objective: We evaluated the influence of glycemic control on cardiovascular outcomes in diabetic patients with acute myocardial infarction (AMI) who underwent successful percutaneous coronary intervention (PCI) with stent placement. Background: In patients presenting with AMI, diabetic status confers adverse cardiovascular outcomes after PCI. However, the influence of glycemic control on outcomes after successful PCI is less well studied. Methods: We examined 231 consecutive diabetes mellitus (DM) patients with AMI who underwent successful primary PCI and had evaluation of glycosylated hemoglobin (HbA1c) from 30 days before to 90 days after AMI. Patients were categorized in 2 groups, controlled DM with HbA1c ≤ 7.0 (N = 83, 36%) and uncontrolled DM with HbA1c > 7.0 (N = 148, 64%). We assessed 12-month cardiovascular outcomes in study groups. Results: Uncontrolled diabetics were younger, tended to be less hypertensive, and had higher baseline glomerular filtration rate and final vessel diameter compared to controlled diabetics. Uncontrolled DM patients had similar major adverse cardiovascular events (MACE; composite of all-cause death, MI, target vessel revascularization [TVR], and stent thrombosis [ST]; 20% vs. 30%, log-rank P = 0.54), death (8.8% vs. 12%, P = 0.40),MI (8.8% vs. 9.6%, P = 0.76), TVR (9.5% vs. 8.4%, P = 0.95), and ST (3.4% vs. 4.8%, P = 0.54) as the controlled diabetics. In Cox regression analysis, after adjustment for baseline differences, glycemic control had no independent influence on study outcomes. Conclusion: Glycemic control, determined by HbA1c, does not seem to influence cardiovascular outcomes in diabetic patients with AMI after successful stent placement.