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Hyperglycemia Linked with TVR After PCI

A study of patients with type 2 diabetes reminds us of the importance of glycemic control in preventing repeat target-vessel revascularization.

Diabetes patients are at higher risk than nondiabetics for restenosis and repeat target-vessel revascularization (TVR) after percutaneous coronary intervention (PCI). Researchers at a single center assessed the relation between glycemic control before elective PCI and subsequent TVR in 179 patients with type 2 diabetes and 60 nondiabetics. Patients with diabetes, defined as those receiving current treatment with insulin or oral hypoglycemic agents, were categorized as having optimal glycemic control (hemoglobin A1c 7%; 52 patients) or suboptimal control (Hb A1c >7%; 127 patients).

Diabetes patients had higher BMIs and more risk factors than nondiabetics, but the two groups had similar angiographic characteristics and rates of stent use (about 68%). The two subgroups with diabetes also had similar angiographic and procedural characteristics. At 12 months, TVR rates were significantly lower among nondiabetics (18%) and diabetes patients with good glycemic control (15%) than among diabetes patients with suboptimal glycemic control (34%). In a multivariate analysis, suboptimal glycemic control was an independent predictor of TVR, and insulin therapy was a borderline predictor. Results were similar when stent recipients were analyzed separately.

Comment: These results highlight the importance of glycemic control for limiting TVR after PCI in patients with type 2 diabetes. However, the study could not identify the relative roles of hyperglycemia, hyperinsulinemia, and other metabolic and inflammatory mediators in restenosis. Nonetheless, when planning PCI in diabetes patients, we have an opportunity to assess and then improve glycemic control, the likely benefits of which are less restenosis and fewer long-term microvascular complications.

— Howard C. Herrmann, MD

Published in Journal Watch Cardiology March 26, 2004

Citation(s):

Corpus RA et al. Optimal glycemic control is associated with a lower rate of target vessel revascularization in treated type II diabetic patients undergoing elective percutaneous coronary intervention. J Am Coll Cardiol 2004 Jan 7; 43:8-14.

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• Medline abstract (Free)

Kornowski R and Fuchs S. Optimization of glycemic control and restenosis prevention in diabetic patients undergoing percutaneous coronary interventions. J Am Coll Cardiol 2004 Jan 7; 43:15-7.

• Original article (Subscription may be required)
• Medline abstract (Free)