Related Experiment Video
Updated: Apr 26, 2026
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Association of glycemic control with mortality in patients with diabetes mellitus undergoing percutaneous coronary
Praneet K Sharma1, Shikhar Agarwal1, Stephen G Ellis1
1From the Department of Interventional Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (P.K.S.); and Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH (S.A., S.G.E., S.S.G., L.C., E.M.T., A.M.L., S.R.K.).
Insights
Poor glycemic control in diabetes patients undergoing percutaneous coronary intervention (PCI) is linked to higher long-term mortality, especially in non-insulin users. Well-controlled diabetes (HbA1c ≤7%) is associated with better outcomes post-PCI.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Diabetes mellitus (DM) negatively impacts outcomes following percutaneous coronary intervention (PCI).
- The relationship between baseline Hemoglobin A1c (HbA1c) levels and long-term mortality after PCI in diabetic patients remains unclear.
Purpose of the Study:
- To investigate the association between baseline HbA1c levels and long-term mortality in patients with diabetes mellitus undergoing PCI.
Main Methods:
- A cohort of 3008 diabetic patients undergoing PCI between 1998 and 2008 was analyzed.
- Patients were categorized by baseline HbA1c levels (≤7%, 7.1%-8.0%, 8.1%-9.0%, 9.1%-10.0%, and >10.0%).
- Multivariable Cox proportional hazards modeling was used for survival analysis.
Main Results:
- Patients with HbA1c >10% were younger and had higher cholesterol and insulin use compared to those with HbA1c ≤7%.
- Higher baseline HbA1c levels showed a trend toward increased mortality.
- Patients with HbA1c >10% had significantly higher long-term mortality (HR 1.52; P=0.002) compared to those with HbA1c ≤7%.
Conclusions:
- Poor glycemic control (HbA1c >10%) is associated with significantly higher long-term mortality after PCI in non-insulin-dependent diabetic patients.
- Insulin-dependent diabetic patients showed no significant difference in mortality across HbA1c categories.
- Maintaining optimal glycemic control (HbA1c ≤7%) is crucial for improving long-term outcomes in diabetic patients undergoing PCI.
Background:
Diabetes mellitus adversely affects outcomes in patients undergoing percutaneous coronary intervention. The association of baseline hemoglobin A1c (HbA1c) at the time of percutaneous coronary intervention with long-term mortality is unknown.
Methods And Results:
Consecutive patients with diabetes mellitus undergoing percutaneous coronary intervention between 1998 and 2008 were identified from our institutional database. Characteristics and outcomes of patients were compared based on HbA1c categories (≤7%, 7.1%-8.0%, 8.1%-9.0%, 9.1%-10.0%, and >10.0%). Among 3008 patients, 1321 had HbA1c ≤7%, 782 with HbA1c 7.1% to 8.0%, 401 with HbA1c 8.1% to 9.0%, 229 with HbA1c 9.1% to 10.0%, and 275 with HbA1c >10%. Compared with low HbA1c (≤7%), those with highest HbA1c (>10%) were younger (56.5 versus 67.5 years), had higher total cholesterol (188 versus 157 mg/dL), more insulin use (54% versus 26%), and presented more often with ST-segment-elevation myocardial infarction (10.9% versus 5.6%). Those with lower HbA1c (≤7%) more often had other comorbidities (more hypertension [90.4% versus 82.5%] and chronic renal failure [14.4% versus 7.6%]). On multivariable Cox proportional hazards modeling, survival analysis demonstrated a trend toward higher mortality with higher HbA1c. Compared with the reference group of patients with HbA1c ≤7%, patients with HbA1c >10% had a significantly higher mortality on follow-up (hazard ratio [95% confidence interval], 1.52 [1.17-1.99]; P=0.002). This difference was primarily seen among noninsulin users; however, insulin users had no significant differences in mortality among HbA1c categories.
Conclusions:
Patients with diabetes mellitus who were not on insulin and had poor glycemic control (HbA1c >10%) had significantly higher long-term mortality after percutaneous coronary intervention as compared with those with well-controlled diabetes mellitus, evidenced by HbA1c ≤7%. Insulin users, however, had similar rates of mortality among different HbA1c categories.
More Related Videos
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:15Diabetes: Management and Pharmacotherapy
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:22Complications of Diabetes Mellitus
01:26Angina IV: Management
01:22Diabetes Mellitus: Type 2 and Gestational