TY - JOUR
T1 - Prediabetes and its Impact on Clinical Outcome After Coronary Intervention in a Broad Patient Population
AU - Kok, Marlies M.
AU - von Birgelen, Clemens
AU - Sattar, Naveed
AU - Löwik, Marije M.
AU - Danse, Peter W.
AU - Schotborgh, Carl E.
AU - Scholte, Martijn
AU - Hartmann, Marc
AU - Kant, Gert D.
AU - Doelman, Cees
AU - Gin, R. Melvyn Tjon Joe
AU - Stoel, Martin G.
AU - van Houwelingen, Gert
AU - Linssen, Gerard C.M.
AU - IJzerman, Maarten Joost
AU - Doggen, Carine
AU - van der Heijden, Liefke C.
AU - Zocca, Paolo
PY - 2018/10/12
Y1 - 2018/10/12
N2 - Aims: It is unclear whether detection of prediabetes (pre-DM) by routine assessment of glycated haemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) among patients undergoing percutaneous coronary intervention (PCI) with contemporary drug-eluting stents (DES) may help identify subjects with increased event risk. We assessed the relation between glycaemia status and one-year outcome after PCI. Methods and results: Glycaemia status was determined in 2,362 non-diabetic BIO-RESORT participants, treated at all four study sites, to identify pre-DM (HbA1c 42-47 mmol/mol; FPG 6.1-6.9 mmol/L) and unknown diabetes mellitus (DM) (HbA1c ≥48 mmol/mol; FPG ≥7.0 mmol/L). Another 624 patients had medically treated DM. The main composite endpoint consisted of death, myocardial infarction, or revascularisation. Glycaemic state was known in 2,986 participants: 324 (11%) patients had pre-DM, 793 (27%) had DM (known or new), and 1,869 (63%) patients had normoglycaemia. Pre-DM and DM patients differed from normoglycaemic patients in cardiovascular risk factors. The composite endpoint occurred in 11.1% in pre-DM, 10.5% in DM, and 5.7% in normoglycaemia (p<0.001). Pre-DM was associated with a twofold higher event risk compared to normoglycaemia (adj. HR 2.0, 95% CI: 1.4-3.0). Conclusions: Following PCI with contemporary DES, all-comers with pre-DM had significantly higher event risks than normoglycaemic patients. In non-DM patients requiring PCI, routine assessment of HbA1c and FPG appears to be of value to identify subjects with increased event risk.
AB - Aims: It is unclear whether detection of prediabetes (pre-DM) by routine assessment of glycated haemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) among patients undergoing percutaneous coronary intervention (PCI) with contemporary drug-eluting stents (DES) may help identify subjects with increased event risk. We assessed the relation between glycaemia status and one-year outcome after PCI. Methods and results: Glycaemia status was determined in 2,362 non-diabetic BIO-RESORT participants, treated at all four study sites, to identify pre-DM (HbA1c 42-47 mmol/mol; FPG 6.1-6.9 mmol/L) and unknown diabetes mellitus (DM) (HbA1c ≥48 mmol/mol; FPG ≥7.0 mmol/L). Another 624 patients had medically treated DM. The main composite endpoint consisted of death, myocardial infarction, or revascularisation. Glycaemic state was known in 2,986 participants: 324 (11%) patients had pre-DM, 793 (27%) had DM (known or new), and 1,869 (63%) patients had normoglycaemia. Pre-DM and DM patients differed from normoglycaemic patients in cardiovascular risk factors. The composite endpoint occurred in 11.1% in pre-DM, 10.5% in DM, and 5.7% in normoglycaemia (p<0.001). Pre-DM was associated with a twofold higher event risk compared to normoglycaemia (adj. HR 2.0, 95% CI: 1.4-3.0). Conclusions: Following PCI with contemporary DES, all-comers with pre-DM had significantly higher event risks than normoglycaemic patients. In non-DM patients requiring PCI, routine assessment of HbA1c and FPG appears to be of value to identify subjects with increased event risk.
KW - ACS/NSTE-ACS
KW - Clinical research
KW - Diabetes
KW - Drug-eluting stent
KW - Miscellaneous
KW - Stable angina
U2 - 10.4244/EIJ-D-17-01067
DO - 10.4244/EIJ-D-17-01067
M3 - Article
VL - 14
SP - e1049-e1056
JO - EuroIntervention
JF - EuroIntervention
SN - 1774-024X
IS - 9
ER -