Poor glycemic control (HbA1c >7.0%) was significantly associated with a higher risk of stent failure compared to HbA1c 6.1-7.0%, with hazard ratios ranging from 1.25 to 1.46.
Observational (n=52,457)
Yes
Does poor glycemic control increase the risk of stent failure in patients with type 2 diabetes mellitus undergoing second-generation drug-eluting stent implantation?
In patients with type 2 diabetes receiving second-generation drug-eluting stents, poor glycemic control is significantly associated with a higher risk of stent failure, driven primarily by in-stent restenosis.
Effect estimate: HR 1.25 (95% CI 1.11-1.41)
BACKGROUND: The impact of glycemic control in the risk of stent failure in subjects with type 2 diabetes (T2D) is currently unknown. OBJECTIVES: This study sought to study whether poor glycemic control is associated with a higher risk of stent failure in subjects with T2D. METHODS: This observational study included all patients in Sweden with T2D who underwent implantation of second-generation drug-eluting stents (DES) during 2010 to 2020. The exposure variable was the updated mean of glycated hemoglobin (HbA1c). Individuals were stratified by glycemic control, with HbA1c 6.1% to 7.0% (43-53 mmol/mol) as the reference group. The primary endpoint was the occurrence of stent failure (in-stent restenosis and stent thrombosis). The main result was analyzed in a complete cases model. Sensitivity analyses were performed for missing data and a model with death as a competing risk. RESULTS: The study population consisted of 52,457 individuals (70,453 DES). The number of complete cases was 24,411 (29,029 DES). The median follow-up was 6.4 years. The fully adjusted HR was 1.10 (95% CI: 0.80-1.52) for HbA1c of ≤5.5% (≤37 mmol/mol), 1.02 (95% CI: 0.85-1.23) for HbA1c of 5.6% to 6.0% (38-42 mmol/mol), 1.25 (95% CI: 1.11-1.41) for HbA1c of 7.1% to 8.0% (54-64 mmol/mol), 1.30 (95% CI: 1.13-1.51) for HbA1c of 8.1% to 9.0% (65-75 mmol/mol), 1.46 (95% CI: 1.21-1.76) for HbA1c of 9.1% to 10.0% (76-86 mmol/mol), and 1.33 (95% CI: 1.06-1.66) for HbA1c of ≥10.1% (≥87 mmol/mol). Sensitivity analyses did not change the main result. CONCLUSIONS: We found a significant association between poor glycemic control and a higher risk of stent failure driven by in-stent restenosis.
“Our results show that people with diabetes, especially type 1 diabetes, have a much higher risk of stent complications. Therefore, it is important to carefully consider how we treat these patients.”
Santos‐Pardo et al. (Tue,) conducted a observational in Type 2 diabetes mellitus (n=52,457). Updated mean of glycated hemoglobin (HbA1c) vs. HbA1c 6.1% to 7.0% (43-53 mmol/mol) was evaluated on Occurrence of stent failure (in-stent restenosis and stent thrombosis) (HR 1.25, 95% CI 1.11-1.41). Poor glycemic control (HbA1c >7.0%) was significantly associated with a higher risk of stent failure compared to HbA1c 6.1-7.0%, with hazard ratios ranging from 1.25 to 1.46.
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