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BACKGROUND: The impact of glycemic control in the risk of stent failure in subjects with type 2 diabetes (T2D) is currently unknown.

OBJECTIVES: This study sought to study whether poor glycemic control is associated with a higher risk of stent failure in subjects with T2D.

METHODS: This observational study included all patients in Sweden with T2D who underwent implantation of secondgeneration drug-eluting stents (DES) during 2010 to 2020. The exposure variable was the updated mean of glycated hemoglobin (HbA_1c ). Individuals were strati fied by glycemic control, with HbA_1c 6.1% to 7.0% (43-53 mmol/mol) as the reference group. The primary endpoint was the occurrence of stent failure (in-stent restenosis and stent thrombosis). The main result was analyzed in a complete cases model. Sensitivity analyses were performed for missing data and a model with death as a competing risk.

RESULTS: The study population consisted of 52,457 individuals (70,453 DES). The number of complete cases was 24,411 (29,029 DES). The median follow-up was 6.4 years. The fully adjusted HR was 1.10 (95% CI: 0.80-1.52) for HbA_1c of ≤ 5.5% (≤ 37 mmol/mol), 1.02 (95% CI: 0.85-1.23) for HbA_1c of 5.6% to 6.0% (38-42 mmol/mol), 1.25 (95% CI: 1.11-1.41) for HbA_1c of 7.1% to 8.0% (54-64 mmol/mol), 1.30 (95% CI: 1.13-1.51) for HbA_1c of 8.1% to 9.0% (65-75 mmol/mol), 1.46 (95% CI: 1.21-1.76) for HbA_1c of 9.1% to 10.0% (76-86 mmol/mol), and 1.33 (95% CI: 1.06-1.66) for HbA_1c of ≥ 10.1% (≥ 87 mmol/ mol). Sensitivity analyses did not change the main result.

CONCLUSIONS: We found a signi ficant association between poor glycemic control and a higher risk of stent failure driven by in-stent restenosis.