“Silent” Diabetes and Clinical Outcome After Treatment With Contemporary Drug-Eluting Stents: The BIO-RESORT Silent Diabetes Study

Clemens von Birgelen* (Corresponding Author), Marlies M. Kok, Naveed Sattar, Cees Doelman, Gert D. Kant, Marije M. Löwik, Liefke C. van der Heijden, Hanim Sen, Gert K. van Houwelingen, Martin G. Stoel, J. (Hans) W. Louwerenburg, Marc Hartmann, Frits H.A.F. de Man, Gerard C.M. Linssen, Carine J.M. Doggen, Kenneth Tandjung, Paolo Zocca

*Corresponding author for this work

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Abstract

Objectives: This study sought to assess the prevalence and clinical impact of silent diabetes and pre-diabetes in “nondiabetic” percutaneous coronary intervention (PCI) all-comers.

Background: Patients with undetected and thus untreated (silent) diabetes may have higher event risks after PCI with contemporary drug-eluting stents (DES).

Methods: The BIO-RESORT Silent Diabetes study, performed at Thoraxcentrum Twente, is a substudy of the randomized multicenter BIO-RESORT (BIOdegradable Polymer and DuRable Polymer Drug-eluting Stents in an All COmeRs PopulaTion) trial (NCT01674803). Patients underwent oral glucose tolerance testing (OGTT), and assessment of glycosylated hemoglobin with fasting plasma glucose. Primary endpoint was a composite of cardiac death, target vessel–related myocardial infarction, or target vessel revascularization at 1 year.

Results: Of the 988 participants, OGTT detected silent diabetes in 68 (6.9%), pre-diabetes in 133 (13.3%), and normal glucose metabolism in 788 (79.8%). Patients with silent diabetes had higher primary endpoint rates (13.2% vs. 7.6% vs. 4.8%; p < 0.001; silent diabetes vs. normal: hazard ratio: 4.2; 95% confidence interval: 1.9 to 9.2). Differences were driven by myocardial infarction (p < 0.001) which occurred mostly <48 h. Based on glycosylated hemoglobin and fasting plasma glucose, silent diabetes was found in 33 (3.3%) patients, pre-diabetes in 217 (22.0%) patients, and normal glucose metabolism in 738 (74.7%) patients; primary endpoint rates were similar to OGTT-based analyses (12.1% vs. 5.5% vs. 3.1%; p = 0.01). Multivariate analyses demonstrated that abnormal glucose metabolism by either diagnostic approach, present in 330 (33.4%) patients, independently predicted adverse event risk (hazard ratio: 2.2; 95% confidence interval: 1.2 to 4.2).

Conclusions: Abnormal glucose metabolism was detected in 1 of 3 “nondiabetic” PCI patients and was independently associated with up to 4-fold higher event risks. Future intervention trials should determine whether meaningful benefits accrue from routine glycemia testing in such patients.

Original languageEnglish
Pages (from-to)448-459
Number of pages12
JournalJACC : cardiovascular interventions
Volume11
Issue number5
DOIs
Publication statusPublished - 12 Mar 2018

Fingerprint

Drug-Eluting Stents
Glucose
Percutaneous Coronary Intervention
Glucose Tolerance Test
Glycosylated Hemoglobin A
Fasting
Polymers
Myocardial Infarction
Confidence Intervals
Multivariate Analysis
Odds Ratio

Keywords

  • Drug-eluting stent(s)
  • HbA
  • Impaired glucose tolerance
  • OGTT
  • Oral glucose tolerance testing
  • PCI
  • Percutaneous coronary intervention
  • Silent diabetes
  • DES

Cite this

von Birgelen, Clemens ; Kok, Marlies M. ; Sattar, Naveed ; Doelman, Cees ; Kant, Gert D. ; Löwik, Marije M. ; van der Heijden, Liefke C. ; Sen, Hanim ; van Houwelingen, Gert K. ; Stoel, Martin G. ; Louwerenburg, J. (Hans) W. ; Hartmann, Marc ; de Man, Frits H.A.F. ; Linssen, Gerard C.M. ; Doggen, Carine J.M. ; Tandjung, Kenneth ; Zocca, Paolo. / “Silent” Diabetes and Clinical Outcome After Treatment With Contemporary Drug-Eluting Stents : The BIO-RESORT Silent Diabetes Study. In: JACC : cardiovascular interventions. 2018 ; Vol. 11, No. 5. pp. 448-459.
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abstract = "Objectives: This study sought to assess the prevalence and clinical impact of silent diabetes and pre-diabetes in “nondiabetic” percutaneous coronary intervention (PCI) all-comers.Background: Patients with undetected and thus untreated (silent) diabetes may have higher event risks after PCI with contemporary drug-eluting stents (DES).Methods: The BIO-RESORT Silent Diabetes study, performed at Thoraxcentrum Twente, is a substudy of the randomized multicenter BIO-RESORT (BIOdegradable Polymer and DuRable Polymer Drug-eluting Stents in an All COmeRs PopulaTion) trial (NCT01674803). Patients underwent oral glucose tolerance testing (OGTT), and assessment of glycosylated hemoglobin with fasting plasma glucose. Primary endpoint was a composite of cardiac death, target vessel–related myocardial infarction, or target vessel revascularization at 1 year.Results: Of the 988 participants, OGTT detected silent diabetes in 68 (6.9{\%}), pre-diabetes in 133 (13.3{\%}), and normal glucose metabolism in 788 (79.8{\%}). Patients with silent diabetes had higher primary endpoint rates (13.2{\%} vs. 7.6{\%} vs. 4.8{\%}; p < 0.001; silent diabetes vs. normal: hazard ratio: 4.2; 95{\%} confidence interval: 1.9 to 9.2). Differences were driven by myocardial infarction (p < 0.001) which occurred mostly <48 h. Based on glycosylated hemoglobin and fasting plasma glucose, silent diabetes was found in 33 (3.3{\%}) patients, pre-diabetes in 217 (22.0{\%}) patients, and normal glucose metabolism in 738 (74.7{\%}) patients; primary endpoint rates were similar to OGTT-based analyses (12.1{\%} vs. 5.5{\%} vs. 3.1{\%}; p = 0.01). Multivariate analyses demonstrated that abnormal glucose metabolism by either diagnostic approach, present in 330 (33.4{\%}) patients, independently predicted adverse event risk (hazard ratio: 2.2; 95{\%} confidence interval: 1.2 to 4.2).Conclusions: Abnormal glucose metabolism was detected in 1 of 3 “nondiabetic” PCI patients and was independently associated with up to 4-fold higher event risks. Future intervention trials should determine whether meaningful benefits accrue from routine glycemia testing in such patients.",
keywords = "Drug-eluting stent(s), HbA, Impaired glucose tolerance, OGTT, Oral glucose tolerance testing, PCI, Percutaneous coronary intervention, Silent diabetes, DES",
author = "{von Birgelen}, Clemens and Kok, {Marlies M.} and Naveed Sattar and Cees Doelman and Kant, {Gert D.} and L{\"o}wik, {Marije M.} and {van der Heijden}, {Liefke C.} and Hanim Sen and {van Houwelingen}, {Gert K.} and Stoel, {Martin G.} and Louwerenburg, {J. (Hans) W.} and Marc Hartmann and {de Man}, {Frits H.A.F.} and Linssen, {Gerard C.M.} and Doggen, {Carine J.M.} and Kenneth Tandjung and Paolo Zocca",
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von Birgelen, C, Kok, MM, Sattar, N, Doelman, C, Kant, GD, Löwik, MM, van der Heijden, LC, Sen, H, van Houwelingen, GK, Stoel, MG, Louwerenburg, JHW, Hartmann, M, de Man, FHAF, Linssen, GCM, Doggen, CJM, Tandjung, K & Zocca, P 2018, '“Silent” Diabetes and Clinical Outcome After Treatment With Contemporary Drug-Eluting Stents: The BIO-RESORT Silent Diabetes Study', JACC : cardiovascular interventions, vol. 11, no. 5, pp. 448-459. https://doi.org/10.1016/j.jcin.2017.10.038

“Silent” Diabetes and Clinical Outcome After Treatment With Contemporary Drug-Eluting Stents : The BIO-RESORT Silent Diabetes Study. / von Birgelen, Clemens (Corresponding Author); Kok, Marlies M.; Sattar, Naveed; Doelman, Cees; Kant, Gert D.; Löwik, Marije M.; van der Heijden, Liefke C.; Sen, Hanim; van Houwelingen, Gert K.; Stoel, Martin G.; Louwerenburg, J. (Hans) W.; Hartmann, Marc; de Man, Frits H.A.F.; Linssen, Gerard C.M.; Doggen, Carine J.M.; Tandjung, Kenneth; Zocca, Paolo.

In: JACC : cardiovascular interventions, Vol. 11, No. 5, 12.03.2018, p. 448-459.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - “Silent” Diabetes and Clinical Outcome After Treatment With Contemporary Drug-Eluting Stents

T2 - The BIO-RESORT Silent Diabetes Study

AU - von Birgelen, Clemens

AU - Kok, Marlies M.

AU - Sattar, Naveed

AU - Doelman, Cees

AU - Kant, Gert D.

AU - Löwik, Marije M.

AU - van der Heijden, Liefke C.

AU - Sen, Hanim

AU - van Houwelingen, Gert K.

AU - Stoel, Martin G.

AU - Louwerenburg, J. (Hans) W.

AU - Hartmann, Marc

AU - de Man, Frits H.A.F.

AU - Linssen, Gerard C.M.

AU - Doggen, Carine J.M.

AU - Tandjung, Kenneth

AU - Zocca, Paolo

PY - 2018/3/12

Y1 - 2018/3/12

N2 - Objectives: This study sought to assess the prevalence and clinical impact of silent diabetes and pre-diabetes in “nondiabetic” percutaneous coronary intervention (PCI) all-comers.Background: Patients with undetected and thus untreated (silent) diabetes may have higher event risks after PCI with contemporary drug-eluting stents (DES).Methods: The BIO-RESORT Silent Diabetes study, performed at Thoraxcentrum Twente, is a substudy of the randomized multicenter BIO-RESORT (BIOdegradable Polymer and DuRable Polymer Drug-eluting Stents in an All COmeRs PopulaTion) trial (NCT01674803). Patients underwent oral glucose tolerance testing (OGTT), and assessment of glycosylated hemoglobin with fasting plasma glucose. Primary endpoint was a composite of cardiac death, target vessel–related myocardial infarction, or target vessel revascularization at 1 year.Results: Of the 988 participants, OGTT detected silent diabetes in 68 (6.9%), pre-diabetes in 133 (13.3%), and normal glucose metabolism in 788 (79.8%). Patients with silent diabetes had higher primary endpoint rates (13.2% vs. 7.6% vs. 4.8%; p < 0.001; silent diabetes vs. normal: hazard ratio: 4.2; 95% confidence interval: 1.9 to 9.2). Differences were driven by myocardial infarction (p < 0.001) which occurred mostly <48 h. Based on glycosylated hemoglobin and fasting plasma glucose, silent diabetes was found in 33 (3.3%) patients, pre-diabetes in 217 (22.0%) patients, and normal glucose metabolism in 738 (74.7%) patients; primary endpoint rates were similar to OGTT-based analyses (12.1% vs. 5.5% vs. 3.1%; p = 0.01). Multivariate analyses demonstrated that abnormal glucose metabolism by either diagnostic approach, present in 330 (33.4%) patients, independently predicted adverse event risk (hazard ratio: 2.2; 95% confidence interval: 1.2 to 4.2).Conclusions: Abnormal glucose metabolism was detected in 1 of 3 “nondiabetic” PCI patients and was independently associated with up to 4-fold higher event risks. Future intervention trials should determine whether meaningful benefits accrue from routine glycemia testing in such patients.

AB - Objectives: This study sought to assess the prevalence and clinical impact of silent diabetes and pre-diabetes in “nondiabetic” percutaneous coronary intervention (PCI) all-comers.Background: Patients with undetected and thus untreated (silent) diabetes may have higher event risks after PCI with contemporary drug-eluting stents (DES).Methods: The BIO-RESORT Silent Diabetes study, performed at Thoraxcentrum Twente, is a substudy of the randomized multicenter BIO-RESORT (BIOdegradable Polymer and DuRable Polymer Drug-eluting Stents in an All COmeRs PopulaTion) trial (NCT01674803). Patients underwent oral glucose tolerance testing (OGTT), and assessment of glycosylated hemoglobin with fasting plasma glucose. Primary endpoint was a composite of cardiac death, target vessel–related myocardial infarction, or target vessel revascularization at 1 year.Results: Of the 988 participants, OGTT detected silent diabetes in 68 (6.9%), pre-diabetes in 133 (13.3%), and normal glucose metabolism in 788 (79.8%). Patients with silent diabetes had higher primary endpoint rates (13.2% vs. 7.6% vs. 4.8%; p < 0.001; silent diabetes vs. normal: hazard ratio: 4.2; 95% confidence interval: 1.9 to 9.2). Differences were driven by myocardial infarction (p < 0.001) which occurred mostly <48 h. Based on glycosylated hemoglobin and fasting plasma glucose, silent diabetes was found in 33 (3.3%) patients, pre-diabetes in 217 (22.0%) patients, and normal glucose metabolism in 738 (74.7%) patients; primary endpoint rates were similar to OGTT-based analyses (12.1% vs. 5.5% vs. 3.1%; p = 0.01). Multivariate analyses demonstrated that abnormal glucose metabolism by either diagnostic approach, present in 330 (33.4%) patients, independently predicted adverse event risk (hazard ratio: 2.2; 95% confidence interval: 1.2 to 4.2).Conclusions: Abnormal glucose metabolism was detected in 1 of 3 “nondiabetic” PCI patients and was independently associated with up to 4-fold higher event risks. Future intervention trials should determine whether meaningful benefits accrue from routine glycemia testing in such patients.

KW - Drug-eluting stent(s)

KW - HbA

KW - Impaired glucose tolerance

KW - OGTT

KW - Oral glucose tolerance testing

KW - PCI

KW - Percutaneous coronary intervention

KW - Silent diabetes

KW - DES

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U2 - 10.1016/j.jcin.2017.10.038

DO - 10.1016/j.jcin.2017.10.038

M3 - Article

AN - SCOPUS:85042004536

VL - 11

SP - 448

EP - 459

JO - JACC : cardiovascular interventions

JF - JACC : cardiovascular interventions

SN - 1936-8798

IS - 5

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