Prediabetes and its Impact on Clinical Outcome After Coronary Intervention in a Broad Patient Population

Marlies M. Kok, Clemens von Birgelen (Corresponding Author), Naveed Sattar, Marije M. Löwik, Peter W. Danse, Carl E. Schotborgh, Martijn Scholte, Marc Hartmann, Gert D. Kant, Cees Doelman, R. Melvyn Tjon Joe Gin, Martin G. Stoel, Gert van Houwelingen, Gerard C.M. Linssen, Maarten Joost IJzerman, Carine Doggen, Liefke C. van der Heijden, Paolo Zocca

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Abstract

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.

Original languageEnglish
Pages (from-to)e1049-e1056
JournalEuroIntervention
Volume14
Issue number9
Early online date9 Jan 2018
DOIs
Publication statusPublished - 12 Oct 2018

Keywords

  • ACS/NSTE-ACS
  • Clinical research
  • Diabetes
  • Drug-eluting stent
  • Miscellaneous
  • Stable angina

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    Kok, M. M., von Birgelen, C., Sattar, N., Löwik, M. M., Danse, P. W., Schotborgh, C. E., ... Zocca, P. (2018). Prediabetes and its Impact on Clinical Outcome After Coronary Intervention in a Broad Patient Population. EuroIntervention, 14(9), e1049-e1056. https://doi.org/10.4244/EIJ-D-17-01067