Paris, France – After percutaneous coronary intervention (PCI), in type 2 diabetes, the risk of stent failure increases with loss of glycemic control, according to data presented during the European Association for Percutaneous Coronary Intervention (EuroPCR) Congress 2024 and published simultaneously in the Journal of the American College of Cardiology .
In patients undergoing revascularization, diabetes has long been identified as an independent risk factor for stent-related complications, including stent failure, but this study demonstrates that the risk is dose-dependent, according to the Dr. Irene Santos-Pardofrom the Department of Cardiology (Södersjukhuset, Stockholm, Sweden).
Dr. Santos-Pardo and her colleagues used several Swedish registries to analyze data from 24,111 diabetic patients who received 29,029 stents. They found that the risk of stent failure was 30% higher in patients whose HbA1c level was above the reference level of 6.1%-7.0%, after adjusting for a long list of variables including body mass index, previous coronary heart disease and interventions, diabetes treatments and PCI variables.
More significantly, they also found that each incremental increase in HbA1c led to an increased risk of stent failure. This risk was 25% higher in people with an HbA1c level between 7.1% and 8.0%, 30% in those with a level between 8.1% and 9.0%, and 46%. in those with a rate between 9.1% and 10.0%.
For people with an HbA1c level above 10.1%, the rate of increase in risk fell to 33%, but Dr. Santos-Pardo said this was likely due to competing risks, including the death.
These results remained remarkably consistent across analyses. The relative risks did not change when people treated with insulin were compared to those who were not. While the impact of poor glycemic control on the risk of stent failure was greater in patients younger than 65 years than in those older, the incremental relationship between the degree of hyperglycemia and risk was the same.
Stent Thrombosis
The study identified several specific risks associated with high HbA1c. The risk of stent thrombosis, for example, increased by 55% in people with an HbA1c level of 9.1% to 10.0%, leading Santos-Pardo to characterize thrombosis as a factor in stent failure associated with hyperglycemia.
The risk of death was also highest in patients with HbA1c levels above 10.0%. However, the risk of myocardial infarction was not significant according to HbA1c stratifications.
There was some indication that low HbA1c may also increase the risk of stent failure. People with an HbA1c level below 5.5% had a 10% increase in risk, although this increase was not statistically significant.
A known risk
There are many mechanisms by which diabetes can increase the risk of adverse outcomes, independent of elevated blood sugar levels. For example, the disease is associated with pro-inflammatory effects, hypertension and adverse effects on other organs, such as the kidneys, but Santos-Pardo pointed out that the risk linked to an HbA1c level high persisted even after regression analysis controlling for most of these factors.
“Achieving good blood sugar control is of considerable importance to avoid stent failure, regardless of other variables,” she said.
“Strict blood glucose control is already recommended in diabetic patients undergoing PCI, as we know it is one of the ways to improve outcomes,” said Dr. Dr Antonio Greco, interventional cardiologist at the University of Catania (Italy). “I think the unique contribution of this study is the detection of significant increases in risk for each incremental increase in HbA1c. »
He adds that this work draws attention to the importance not only of careful control, but also of the use of antidiabetic therapies associated with cardiovascular benefit, such as glucagon-like peptide 1 agonists and inhibitors of sodium-glucose cotransporter 2.
This article was translated from Medscape.com using multiple editorial tools, including AI, in the process. The content was reviewed by the editorial staff before publication.
