Abstract 11542: Prognostic Significance of Insulin Treatment and Glucose Control Status on Clinical Cardiovascular Outcomes in Diabetic Patients Who Underwent Elective PCI Using Drug-Eluting Stents
Background: The aim of this study was to evaluate prognostic impact of insulin treatment and glucose control status on cardiovascular outcomes in diabetic patients after elective coronary intervention using drug-eluting stents (DES).
Methods: A total of 198 consecutive diabetic patients undergoing elective percutaneous coronary intervention (PCI) with DES in Chubu Rosai Hospital from October 2005 to March 2008 were enrolled. The median HbA1c value of the patients was 7.5%. Patients were divided into four groups based on the presence or absence of insulin treatment and the HbA1c value at baseline (<7.5% or ≧7.5%). The endpoint of this study was major adverse cardiac event (MACE) defined as the composite of cardiovascular death, non-fatal myocardial infarction and any revascularization.
Results: During the median follow-up of 1454 days, total 87 events occurred. MACE occurred more frequently in insulin-treated group with HbA1c<7.5% (78.9%) than in the other groups (log-rank p < 0.0001). The incidence of cardiac death or non-fatal myocardial infarction (p=0.022) and any revascularization (p=0.025) were significantly increased in insulin-treated group with HbA1c<7.5% than the other groups. In cox analysis, after adjustment for conventional risk factors (age, sex, body mass index, smoking status, hypertention, dyslipidemia) and duration of diabetes, fasting blood glucose, hemodialysis, the hazard ratio for MACE relative to non-insulin-treated group with HbA1c<7.5% was 2.91 (95% confidence interval 1.09 - 7.81, p = 0.034) in insulin-treated group with HbA1c<7.5%. Compared with insulin-treated group with HbA1c≧7.5%, the hazard ratio was 3.83 (95% confidence interval 1.01 - 14.54, p = 0.049) in insulin-treated group with HbA1c<7.5%.
Conclusion: Insulin treatment with lower HbA1c value was proven to be an independent predictor of MACE in diabetic patients after PCI using DES.
Author Disclosures: A. Kunimura: None. T. Uetani: None. T. Kataoka: None. M. Takeshita: None. K. Harada: None. S. Okumura: None. N. Shinoda: None. K. Harada: None. B. Kato: None. M. Kato: None. N. Marui: None. M. Nanki: None. T. Matsubara: None. H. Ishii: None. T. Amano: None. T. Murohara: None.
- © 2014 by American Heart Association, Inc.