Glycemic control and outcome of diabetic patients after successful percutaneous coronary revascularization

Objective Our purpose was to examine whether the outcome of diabetic patients after successful percutaneous coronary revascularization (PCR) is influenced by the degree of control of hyperglycemia at the time of revascularization. Background Diabetic patients have a worse outcome after PCR. Methods We examined whether the degree of glycemic control (HbA1c levels) affected the occurrence of all-cause death and death/myocardial infarction among diabetic patients after successful PCR from October 1979 through December 1998. HbA1c was analyzed both as a continuous and a categorical variable (good [HbA1c <8.0%, N = 700], moderate [8.0% ≤ HbA1c ≤10%, N = 442], or poor [HbA1c >10%, N = 231] control). Results HbA1c levels were determined at a median (25th, 75th interquartiles) of 3 (1, 10) days after the index procedure for patients with good control, 2 (1, 7) days for moderate control, and 2 (1, 6) days for poor control. Median follow-up after successful PCR was 3.2 (1.2, 6.1) years, 3.9 (1.7 ,6.3) years, and 4.7 (2.1, 7.1) years, respectively. HbA1c as a continuous variable did not have an impact on either death (hazard ratio [95% confidence interval] 1.04 [0.98-1.10]) or death/myocardial infarction (1.02 [0.98-1.07]). As a categorical variable, patients with moderate and poor control had a similar hazard of death (0.99 [0.78-1.26] and 1.14 [0.86-1.52], respectively) and death/myocardial infarction (1.01 [0.82-1.24] and 1.12 [0.87-1.45], respectively) relative to those with good control. Conclusions The degree of glycemic control among diabetic patients at the time of their index intervention did not have an impact on long-term outcomes after successful PCR. (Am Heart J 2001;141:117-23.)