Glycemic Variability and Adverse Post-PCI Outcomes: A Retrospective Cohort Analysis

Abstract Background Glycemic variability has emerged as an important metabolic determinant associated with oxidative stress, endothelial dysfunction, inflammatory activation, and myocardial injury. Although chronic hyperglycemia is a recognized cardiovascular risk factor, acute fluctuations in glucose concentration may independently contribute to adverse cardiovascular outcomes following percutaneous coronary intervention (PCI). The prognostic significance of post-procedural glycemic variability remains incompletely characterized in contemporary interventional cardiology populations. Objective The present study evaluated the relationship between glycemic variability and adverse short-term cardiovascular outcomes following PCI in a tertiary academic cardiovascular center. Methods A prospective observational cohort study was conducted involving 1,524 adult patients undergoing PCI during a recent multi-year study period. Serial glucose measurements were obtained during the first 72 hours following coronary intervention. Glycemic variability was assessed using coefficient of variation and mean amplitude of glycemic excursion. The primary endpoint consisted of 90-day major adverse cardiovascular events (MACE), including cardiovascular mortality, recurrent myocardial infarction, target vessel revascularization, acute heart failure hospitalization, ventricular arrhythmia, and cardiogenic shock. Multivariable Cox proportional hazards regression analysis was performed to identify independent predictors of adverse cardiovascular outcomes. Results Among the included population, 472 patients (31.0%) demonstrated elevated glycemic variability during the early post-procedural period. Patients with elevated glycemic variability experienced significantly higher rates of recurrent myocardial infarction, acute heart failure hospitalization, ventricular arrhythmia, cardiogenic shock, ICU admission, and cardiovascular mortality compared with patients demonstrating stable glucose profiles. Glycemic coefficient of variation greater than 25% independently predicted MACE (adjusted HR 3.11; 95% CI 2.14–4.66), together with peak glucose concentration greater than 240 mg/dL (adjusted HR 2.63; 95% CI 1.82–3.89), left ventricular ejection fraction below 40% (adjusted HR 2.28; 95% CI 1.53–3.42), and multivessel coronary artery disease (adjusted HR 1.92; 95% CI 1.29–2.81). Conclusion Elevated glycemic variability following PCI was strongly associated with adverse cardiovascular outcomes and increased short-term mortality. Early metabolic stabilization and integrated glucose monitoring may improve post-intervention cardiovascular risk stratification and facilitate targeted preventive strategies.