Poor glycaemic control ups risk of stent failure in T2D patients

Poor glycaemic control appears to contribute to coronary stent failure driven by in-stent restenosis in patients with type 2 diabetes (T2D), suggests a study.

A total of 52,457 individuals were included in the analysis, and the number of completed cases was 24,411, with 29,029 drug-eluting stent (DES) implantations. The median follow-up was 6.4 years.

Poor glycaemic control correlated with stent failure, with fully adjusted hazard ratios (HR) of 1.10 (95 percent confidence interval [CI], 0.80‒1.52) for HbA1c of ≤5.5 percent (≤37 mmol/mol), 1.02 (95 percent CI, 0.85‒1.23) for HbA1c of 5.6 percent to 6.0 percent (38‒42 mmol/mol), and 1.25 (95 percent CI, 1.11‒1.41) for HbA1c of 7.1 percent to 8.0 percent (54‒64 mmol/mol).

Furthermore, the fully adjusted HRs for HbA1c of 8.1 percent to 9.0 percent (65‒75 mmol/mol), 9.1 percent to 10.0 percent (76‒86 mmol/mol), and ≥10.1 percent (≥87 mmol/mol) were 1.30 (95 percent CI, 1.31‒1.51), 1.46 (95 percent CI, 1.21‒1.76), and 1.33 (95 percent CI, 1.06‒1.66), respectively. These results persisted in sensitivity analyses.

Patients with T2D who underwent implantation of second-generation DES during 2010 to 2020 in Sweden were included in this observational study. The updated mean of HbA1c served as the exposure variable. Participants were categorized by glycaemic control, with HbA1c 6.1 percent to 7.0 percent (43‒53 mmol/mol) as the reference group.

Stent failure (in-stent restenosis and stent thrombosis) was the primary endpoint. A complete case model was used to analyse the main result. Finally, the authors performed sensitivity analyses for the missing data and used death as a competing risk.