Correlation between Angiographic in-Stent Restenosis and Post-procedural Glycosylated Hemoglobin Level in Diabetic Patients underwent Percutaneous Coronary Intervention with Drug eluting Stent

Abstract

Background: Diabetes mellitus is a common, complex, and chronic metabolic disorder act as an important modifiable risk factor for cardiovascular disease and has been shown to be an independent predictor for in-stent restenosis after percutaneous coronary intervention.
Objectives: To determine the influence of HbA1c level on the frequency of in-stent restenosis in diabetic patients after elective percutaneous coronary intervention.
Patients and Methods: 89 diabetic patients with recurrent ischemia had history of previous percutaneous coronary intervention and stented coronary arteries with drug eluting stent were admitted to the Iraqi Center for Heart Diseases for elective coronary catheterization with or without percutaneous coronary intervention in period between April 2013 and March 2014. All patients were evaluated thoroughly. 26 patients were excluded for different reasons. 63 patients were assessing for stent patency during catheterization. 29 patients with patent stents. 34 patients with in-stent restenosis were investigated with HbA1c level. Diabetes mellitus was defined as fasting blood sugar concentration ≥126 mg/dl, random blood sugar ≥200 mg/dl with suggestive symptoms or positive history of diabetes mellitus with diet control or use an oral hypoglycemic agent(s) or insulin at the time of admission. Patients with in-stent restenosis were categorized into two groups based on their HbA1c level, good glycemic control (HbA1c ≤ 7%) and poor glycemic control (HbA1c>7%).
Results: Males represent 19 (55.9%) and females represent 15 (44.1%) of diabetic patients with in-stent restenosis. In table 2, 27 (79.45%) diabetic patients with poor glycemic control more likely to have in-stent restenosis than 7 (20.6%) patients with good glycemic control, P.value < 0.005. In table 4 in-stent restenosis more likely to occur in non-proximal left anterior descending artery after elective PCI in 20 out of 27 patients with poor glycemic control, P.value < 0.005.
Conclusions: Our study reveals that there is a correlation between poor glycemic control and increased frequency of in-stent restenosis of drug eluting stents in diabetic patients. Poor glycemic controlled diabetic patients are more liable for in-stent restenosis of drug eluting stents after intervention in non-proximal left anterior descending artery.