Visit-to-visit HbA1cvariability is associated with in-stent restenosis in patients with type 2 diabetes after percutaneous coronary intervention
Visit-to-visit HbA1cvariability is associated with in-stent restenosis in patients with type 2 diabetes after percutaneous coronary intervention
复制标题
就诊 HbA(1c) 变异与 2 型糖尿病患者经皮冠状动脉介入治疗后支架内再狭窄相关
DOI：
10.1186/s12933-020-01111-7
复制
发表时间：
2020-09-04
影响因子：
9.3
通讯作者：
Wang, Xiao Qun
中科院分区：
文献类型：
--
作者：
Yang, Chen Die;Shen, Ying;Wang, Xiao Qun
背景2型糖尿病患者在冠状动脉支架植入术后支架内再狭窄（ISR）的风险明显较高。我们试图研究访视间HbA（1c）变异性是否是糖尿病患者支架植入术后ISR的潜在预测因素。方法连续入选成功接受择期经皮冠状动脉介入治疗的2型糖尿病患者，并在约12个月后进行随访冠状动脉造影。研究了ISR的发生率及其与访视间HbA（1c）变异性的关系，表示为变异系数（CV）、标准差（SD）和与平均值无关的变异性（Vim）。构建多变量考克斯比例风险模型分析HbA（1c）变异性对ISR的预测价值。结果2014年9月至2018年7月在瑞金医院共纳入420例糖尿病患者（688处病变）支架植入术后纳入最终分析。在平均12.8 ± 1.3个月的随访期间，ISR的发生率为8.6%，在HbA（1c）CV较高的患者中显著增加（P = 0.001）。平均直径狭窄（DS）、净管腔损失和净管腔增加分别为22.9 ± 16.8%、0.42 ± 0.88 mm和1.66 ± 0.83 mm。在HbA（1c）CV较高的受试者中观察到较大的DS（P < 0.001），并且这种趋势在血糖控制最佳（HbA（1c））的患者中更为突出。
Background Patients with type 2 diabetes are under substantially higher risk of in-stent restenosis (ISR) after coronary stent implantation. We sought to investigate whether visit-to-visit HbA(1c)variability is a potential predictor of ISR in diabetic patients after stent implantation. Methods We consecutively enrolled type 2 diabetic patients who underwent successful elective percutaneous coronary intervention and performed follow-up coronary angiography after around 12 months. The incidence of ISR and its relationship with visit-to-visit HbA(1c)variability, expressed as coefficient of variation (CV), standard deviation (SD) and variability independent of the mean (VIM), were studied. Multivariable Cox proportional hazards models were constructed to analyze the predictive value of HbA(1c)variability for ISR. Results From September 2014 to July 2018 in Ruijin Hospital, a total of 420 diabetic patients (688 lesions) after stent implantation were included in the final analysis. During a mean follow-up of 12.8 +/- 1.3 months, the incidence of ISR was 8.6%, which was significantly increased in patients with higher CV of HbA(1c)(P = 0.001). The mean diameter stenosis (DS), net luminal loss and net luminal gain were 22.9 +/- 16.8%, 0.42 +/- 0.88 mm and 1.66 +/- 0.83 mm, respectively. Greater DS was observed in subjects with higher tertiles of CV of HbA(1c)(P < 0.001), and this trend was more prominent in patients with optimal glycemic control (HbA(1c)