Objectives We examined the association between glycaemic control determined by fasting glucose levels before elective PCI and the outcomes in diabetic patients undergoing elective revascularization.
Background Patients with diabetes mellitus (DM) have a worse clinical outcome after PCI than patients without DM, but whether optimal glycaemic control before PCI could improve the prognosis is not clear.
Methods The DESIRE-2 (Drug-Eluting Stent Impact on Revascularization-2) was a single-center registry of coronary revascularization in our institution between July 1st 2003 and Sep 30th 2005. A total of 434 diabetic patients undergoing elective PCI were enrolled in this study. Optimal glycaemic control was defined as fasting glucose <126 mg/dl, and suboptimal control was defined as fasting glucose >=126 mg/dl. Median follow-up duration after the index intervention was 523 days.
Results The average patient age was 61.0±9.8 years; 69.8% of the patients were men. The patients with optimal glycaemic control were older than the suboptimal control group (62.1±9.46 vs 59.6±10.41). Compared with diabetic patients with optimal glycaemic control, those with suboptimal glycaemic control had similar rates of total mortality (3.3% vs 3.9%, p=0.762) and major adverse cardiac and cerebral events (15.9% vs 12.4%, p=0.308). In a multiple Cox regression analysis, total cholesterol level (HR 1.009, 95% CI 1.002 to 1.016, p=0.013) and number of lesion (HR 2.070, 95% CI 1.340 to 3.199, p=0.001) were significant independent predictors of MACCE.
Conclusions In diabetic patients undergoing elective PCI, optimal glycaemic control did not improve clinical prognosis. These data suggest that aggressive treatment of DM to achieve fasting glucose <126 mg/dl before PCI is not necessary.