Weiguo Chen,1,2 Pan Chang,2 Qiuhe Wang,1 Xiaona Niu,1 Yan Li1 

1Department of Cardiology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, People’s Republic of China; 2Department of Cardiology, Second Affiliated Hospital of Xi’an Medical University, Xi’an, People’s Republic of China

Correspondence: Yan Li, Department of Cardiology, Tangdu Hospital, The Fourth Military Medical University, No. 569 Xinsi Road, Baqiao District, Xi’an, 710000, Shaanxi Province, People’s Republic of China, Tel +86-2984777777, Email profleeyan@163.com

Aim: This 10-year study aimed to evaluate how glycaemic control, diabetes duration and coronary stenosis severity affect mortality in patients with stable coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) and to perform multifactorial risk analysis to find key modifiable factors for better risk stratification and secondary prevention.
Methods: This retrospective cohort study involved 150 patients with T2DM with chronic coronary syndrome who had coronary angiography at a single centre between 2011 and 2012. Demographic and biochemical data were collected. Patients were divided into intensified and relaxed control groups based on glycated haemoglobin (HbA1c) levels (≤ 7.5% and > 7.5%). The Gensini score was used to assess coronary angiography results. Multivariate Cox regression analysis was used to find risk factors. Kaplan–Meier analysis was used to compare glycaemic control incidence in subgroups.
Results: The median diabetes duration was 2.0 years. Adjusted hazard ratios (95% CI) for all-cause mortality were 1.10 (1.06– 1.15) for age, 1.29 (1.12– 1.48) for HbA1c, 1.06 (1.02– 1.10) for diabetic duration and 1.02 (1.01– 1.02) for Gensini score. For cardiovascular mortality, the ratios were 1.10 (1.05– 1.15) for age, 1.36 (1.16– 1.58) for HbA1c, 1.06 (1.00– 1.10) for diabetic duration, 1.12 (1.04– 1.23) for direct bilirubin, 0.89 (0.83– 0.95) for serum total protein and 1.02 (1.01– 1.03) for Gensini score. Kaplan–Meier analysis showed higher cardiovascular mortality in patients with HbA1c > 7.5% and diabetic duration > 10 years (p = 0.0004).
Conclusion: When deciding on glycaemic control, individual frailty, life expectancy, diabetes duration and coronary stenosis should be considered. This study combines diabetes duration, Gensini-scored coronary stenosis severity and glycaemic control into a prognostic model, providing a new framework for personalised risk stratification in patients with T2DM with stable CAD.

Keywords: intensive glucose control, relaxed glycaemic control, Gensini score, diabetes duration