Glycosylated hemoglobin (HBA1c) levels as follow-up for restenosis clinical outcomes after coronary artery stenting in patients with diabetes mellitus

Diabetes has been shown to be independent predictor of restenosis after percutaneous coronary intervention (PCI). Diabetes mellitus has been proved to be a strong risk factor for in-stent restenosis. Restenosis after stent implantation remains the “Achilles’heel” of PCI, and patients with diabetes still have poorer clinical outcomes compared to non-diabetics.1 (Aim of work) The aim of the present study is to evaluate whether the level of HbA1c as an indicator for the glycaemic control in diabetic patient is related to major cardiovascular events during the follow up in diabetic patients after percutaneous coronary intervention [(PCI) – stenting]. This study included 60 patients with diabetes 41 patient on oral hypoglycemic agent and 19 patient on insulin at the time of the study. These patients included 44 male (73.3%) and 16 female (26.7%) with mean age 56.48 ± 7.8 years. All patients were subjected to stress thallium at the end of follow-up period (24 month) or at the occurrence of the cardiac events. Follow-up HbA1c were performed before stenting and every 6 month till the end of follow-up period. In the study, 30 non-diabetic patients, who underwent stenting, were enrolled as control. Regarding the duration of diabetes mellitus (in years), patients who had cardiac events had longer duration of DM than who did not (12.83 ± 6.8, 8.17 ± 3.3 yrs with p-value = 0.002). LDL level was lower in the patients who had no cardiac events than who did (108 ± 2.15 mg/dl, 123.67 ± 22.5 mg/dl with p-value = 0.01). While patients who had cardiac events were on shorter duration of clopidogrel than those who did not (9.7 ± 6.8 month, 16.4 ± 7.0 month with p-value ⩽ 0.01). Regarding the HbA1c levels, HbA1c in the patients with cardiac events was ⩾7% while in the none cardiac event patients was ⩽7% with p-value < 0.01. Also, HBA1c during stenting was higher than HBA1c during follow-up in the whole diabetic group (9.12 ± 1.67%, 7.45 ± 2.0% with p-value <0.01. In diabetic patients undergoing coronary artery stenting, patients with HbA1c levels ⩽7% may have lower risk of restenosis and have better clinical outcome after PCI at 2-year follow-up. Clopidogrel may reduce the risk of restenosis in diabetic patients who underwent coronary artery stenting when used for more than 12 month or more (12–24 month).