Key result
In elderly patients with coronary heart disease and type 2 diabetes, fasting blood glucose ≥6.5 mmol/L (OR 5.50) and high HbA1c variability were independent risk factors for in-stent restenosis.
Why the study?
Risk factors related to in-stent restenosis within 2 years after first drug-eluting stent implantation in elderly patients with coronary heart disease and type 2 diabetes needed investigation.
What are the independent risk factors for in-stent restenosis within 2 years in elderly patients with coronary heart disease and type 2 diabetes undergoing first drug-eluting stent implantation?
Case-Control (n=1,843)
No
What are the independent risk factors for in-stent restenosis within 2 years in elderly patients with coronary heart disease and type 2 diabetes undergoing first drug-eluting stent implantation?
Odds Ratio: 5.5 (95% CI 3.05–9.92)
p-value: p=<0.001
In elderly diabetic patients undergoing drug-eluting stent implantation, perioperative fasting blood glucose and long-term HbA1c variability are significant predictors of in-stent restenosis.
These associations may guide risk stratification post-DES in elderly T2DM; hypothesis-generating for prospective trials.
Background: The present study aims to explore risk factors related to in-stent restenosis (ISR) in elderly patients with coronary heart disease and type 2 diabetes within 2 years after the first drug-eluting stent (DES) implantation. Methods: This case-control study retrospectively analyzed the clinical data of patients with coronary heart disease and diabetes undergoing percutaneous coronary intervention (PCI) in Shenzhen Sun Yat-sen Cardiovascular Hospital between January 2010 and March 2020. Univariate and multivariate models were used to assess independent factors for DES-ISR. Categorical principal component analysis of clinical variables was performed to determine important components for DES-ISR. Nomogram was constructed to quantitatively predict the probability of DES-ISR development. The diagnostic potential of clinical variables was determined by receiver operating characteristic curve. Results: , fasting blood glucose ≥6.5 mmol/L, multivessel coronary artery disease, coronary artery diffuse disease, PCI operation time (≥60 min), emergency PCI were associated with ISR. High Nomogram score was associated with the increased risk of ISR. Further analysis of the validation cohort showed that higher levels of HbA1c-coefficient of variation (CV) were significantly associated with the increased risk of ISR. HbA1c-CV exhibited good predictive ability for ISR in the validation cohort. Conclusions: In conclusion, the fasting blood glucose level during the perioperative period of emergency PCI and the long-term variation of HbA1c during the follow-up period are related to the incidence of DES-ISR and the degree of stenosis. Reducing blood glucose fluctuations may decrease the risk of DES-ISR.
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Yi et al. (2022) conducted a case-control in Coronary heart disease and type 2 diabetes (n=1,843). Fasting blood glucose ≥6.5 mmol/L and high HbA1c variability vs. Patients without these risk factors was evaluated on In-stent restenosis (ISR) (OR 5.50, 95% CI 3.05-9.92, p=<0.001). In elderly patients with coronary heart disease and type 2 diabetes, fasting blood glucose ≥6.5 mmol/L (OR 5.50) and high HbA1c variability were independent risk factors for in-stent restenosis.
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