Incremental rise in glycated hemoglobin in diabetics associated with Stent failure after PCI: Study

Type 2 diabetes is a prevalent condition that often requires the use of drug-eluting stents to manage coronary artery disease. However, the impact of glycemic control on the success and longevity of these stents has not been well understood. This study aimed to investigate whether poor glycemic control, as indicated by higher levels of glycated hemoglobin (HbA1c), is associated with an increased risk of stent failure, including in-stent restenosis and stent thrombosis.

The primary objective of the study was to determine the association between HbA1c levels and the risk of stent failure in T2D patients. The study sought to identify if patients with poor glycemic control were at higher risk compared to those with better-controlled blood sugar levels.

This observational study included all patients in Sweden with T2D who underwent implantation of second-generation DES from 2010 to 2020. The primary exposure variable was the updated mean HbA1c. Patients were stratified based on their HbA1c levels, with those having HbA1c between 6.1% to 7.0% (43-53 mmol/mol) serving as the reference group. The primary endpoint was the occurrence of stent failure, defined as in-stent restenosis and stent thrombosis. The main analysis was performed using a complete cases model, with sensitivity analyses conducted to account for missing data and the impact of death as a competing risk.

The study analyzed data from 52,457 individuals who received 70,453 DES. Among these, 24,411 individuals (29,029 DES) had complete data for analysis. The median follow-up period was 6.4 years. The hazard ratios (HR) for stent failure, fully adjusted for confounders, showed a significant increase with higher HbA1c levels. Specifically:

• HbA1c ≤5.5% (≤37 mmol/mol): HR 1.10 (95% CI: 0.80-1.52)

• HbA1c 5.6% to 6.0% (38-42 mmol/mol): HR 1.02 (95% CI: 0.85-1.23)

• HbA1c 7.1% to 8.0% (54-64 mmol/mol): HR 1.25 (95% CI: 1.11-1.41)

• HbA1c 8.1% to 9.0% (65-75 mmol/mol): HR 1.30 (95% CI: 1.13-1.51)

• HbA1c 9.1% to 10.0% (76-86 mmol/mol): HR 1.46 (95% CI: 1.21-1.76)

• HbA1c ≥10.1% (≥87 mmol/mol): HR 1.33 (95% CI: 1.06-1.66)

Sensitivity analyses confirmed these findings, indicating robust results across different analytical models.

The study clearly demonstrates that poor glycemic control is associated with a higher risk of stent failure in T2D patients, primarily due to in-stent restenosis. These findings underscore the importance of stringent glycemic control in patients undergoing DES implantation to enhance stent longevity and reduce complications.

The study concludes that poor glycemic control significantly elevates the risk of stent failure in T2D patients. This association highlights the necessity for rigorous monitoring and management of blood sugar levels in patients receiving drug-eluting stents. Ensuring optimal glycemic control could be a critical strategy to improve stent outcomes and reduce the incidence of in-stent restenosis.

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