Abstract 1956: Intensive Glycemic Control Reduces In-Stent Restenosis in Diabetic Patients Presenting with Acute Coronary Syndrome or Symptomatic Angina
Background: Percutaneous coronary intervention (PCI) in diabetic patients is associated with increased rates of cardiovascular morbidity and a higher incidence of restenosis with need for repeat revascularization. Prior work has suggested that strict glycemic control may reduce rates of restenosis in selected patients undergoing elective PCI; however this data is limited by a small number of patients, and its applicability to patients with an acute coronary syndrome (ACS) or symptomatic angina remains unclear. We investigated the effect of intensive glycemic control on the rate of restenosis (ISR) in the diabetic population.
Methods: Out of a database of 5239 diabetic patients undergoing diagnostic angiography, we identified 256 previously stented patients who presented with ACS or anginal symptoms and subsequently underwent diagnostic angiography. The cohort included 128 patients with target vessel restenosis (> 50% luminal diameter) and 127 controls matched by age, sex, gender, stent type (drug eluting vs. bare metal) and dimension. Baseline clinical and laboratory data at the time of initial intervention were prospectively collected for both groups. Intensive glycemic control was defined by hemoglobin A1c < 7% at the time of PCI and elevated ultrasensitive C-reactive protein (usCRP) was defined as greater than the median level of the population.
Results: The mean age was 64 ± 10, 64% were men, 91% were Type II diabetics, 84% were treated with statins and 35% of patients received drug eluting stents. Patients who developed ISR were more likely to have an elevated level (> 1.8 mg/dl) of ultrasensitive C-reactive protein (58 versus 41%, p = 0.021) but had similar levels of LDL cholesterol and equal frequencies of statin use. Patients with ISR were more likely to be hypertensive (94% vs. 78%, p = 0.002) and were less likely to have intensively controlled glucose (25% vs. 43%, p = 0.026).
Conclusions: In diabetics undergoing PCI due to ACS or anginal symptoms, intensive glycemic control reduced rates of ISR. In addition, elevated usCRP and hypertension were independently associated with increased rates of ISR. These data suggest that inflammation and hyperglycemia may play key roles in the pathogenesis of ISR and should be targeted for aggressive medical therapy.