Synergistic Impact of Glycaemic Control and Coronary Stenosis Severity on Long-Term Prognosis in Diabetes with Chronic Coronary Syndrome: A Ten-Year Retrospective Study.

Abstract

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.