Abstract 1243: Impact of Glycemic Control on Cardiovascular Outcome in Diabetic Patients Undergoing Coronary Revascularization.
Although glycemic control clearly reduces microvascular complications in patients (pts) with diabetes mellitus (DM), it is uncertain whether strict glycemic control can reduce cardiovascular events. There is also a serious concern that strict glycemic control may increase mortality of diabetic pts. To evaluate the association of glycemic control status with cardiovascular events in diabetic pts who underwent coronary revascularization. A total of 9,877 Japanese pts who underwent first PCI or CABG in 2000 –2002 have been registered to CREDO-Kyoto multicenter registry. The study subjects consist of 4180 pts from CREDO-Kyoto whose HbA1c levels at index hospitalization were available: non DM; 2186, DM with HbA1c<6% (strict control group: SG); 341, 6%≤HbA1c<7% (good control group: GG); 604, 7%≤HbA1c<8% (moderate control group: MG); 508, 8%≤HbA1c (poor control group: PG); 541. Pts with acute myocardial infarction (MI) or malignant disease were not included. Average follow up period was 1265±491 days.
Results: The rate of freedom from all death (AD), cardiovascular death (CVD), and composite events (CE) of CVD, MI and stroke were as follows: non DM, SG, GG, MG, PG at 3 years; AD; 92.8%, 85.9%, 92.5%, 91.5%, 89.6%, p<0.0001, CVD; 95.5%, 90.7%, 94.3%, 95.4%, 91.8%, p<0.0001, CE; 90.9%, 83.3%, 86.5%, 86.7%, 83.3%, p<0.0001. Because the prevalence of important prognostic factors such as anemia, chronic kidney disease and history of stroke was significantly higher in SG, multivariable Cox proportional hazard models were employed to adjust the pts’ background for 23 parameters. The results indicated that poor glycemic control was associated with an increased risk of AD, CVD and CE (Table⇓). In diabetic pts undergoing first coronary revascularization, poor glycemic control but not strict glycemic control was associated with adverse cardiovascular outcomes, when baseline demographic and clinical characteristics were adjusted.