Impact of post-challenge hyperglycemia on clinical outcomes in japanese patients with stable angina undergoing percutaneous coronary intervention
Open accessAbstract
BACKGROUND: Post-challenge hyperglycemia (PH) is well-established as one of risk factors for coronary artery disease. However, it remains unclear whether PH affects clinical outcomes in patients with stable angina undergoing percutaneous coronary intervention (PCI). METHODS: A total of 828 patients with stable angina undergoing PCI were retrospectively analyzed. Of these, 452 patients with previously diagnosed diabetes mellitus (DM) or fasting plasma glucose (PG) ≥126 mg/dl and HbA1c ≥6.5% were defined as known DM. The remaining 376 patients were divided into the two groups according to 2-h PG: PH (2-h PG ≥140 mg/dl, n=236) and normal glucose tolerance (NGT, 2-h PG <140 mg/dl, n=140). We assessed the rate of major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, and clinically-driven revascularization. RESULTS: During the median follow-up of 4.3 years, the MACE rate was significantly higher in the DM and PH groups than the NGT group (39.3% vs. 20.7%, P <0.001; 31.4% vs. 20.7%, P=0.044, respectively). Compared with the NGT group, the cumulative incidence of revascularization was significantly higher in the DM group (35.1% vs. 18.5%, P <0.001) and tended to be higher in the PH group (27.1% vs. 18.5%, P=0.067). In the multivariate analysis, known DM (Hazard ratio [HR]: 2.16, 95% confidence interval (CI): 1.49-3.27, P < 0.001), PH (HR: 1.62, 95% CI: 1.07-2.53, P = 0.023), LDL-C >100 mg/dl (HR: 1.62, 95% CI: 1.26 to 2.10, P < 0.001), and previous stroke (HR: 1.47, 95% CI: 1.03-2.04, P = 0.034) were predictors of MACE. CONCLUSION: PH is associated with future cardiovascular events in patients with stable angina undergoing PCI.
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Prognosis of CAD in diabetic patients is worse than in non-diabetic subjects.
“prognosis of CAD in diabetic patients is worse than in non-diabetic subjects137–139)”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [138]
Secondary prevention of CAD in diabetic patients shows a high rate of recurrence.
“Secondary-prevention of CAD in diabetic patients shows a high rate of recurrence137–139, 839), and it is difficult to achieve plaque regression in patients with DM even with the recommended control of LDL-C-lowering therapy840).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [138]
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- Authors
- Kuramitsu, S., Yokoi, H., Domei, T., Nomura, A., Watanabe, H., Yamaji, K., Soga, Y., Arita, T., Kondo, K., Shirai, S., Ando, K., Sakai, K., Iwabuchi, M., Nosaka, H., & Nobuyoshi, M.
- Affiliations
- Kokura Memorial Hospital (JP)
- Corresponding author
- Kuramitsu, Shoichi
- ORCID
- Venue
- Cardiovascular Diabetology
- Published
- 2013
- Volume
- 12
- Issue
- 1
- Pages
- 74
- ISSN
- 1475-2840 (ISSN-L)
- PMC
- PMC3651729
- OpenAlex
- W2170459143
- Cited by
- 26
- References
- 54
- Citations by year
- 2023: 2 · 2022: 3 · 2019: 4 · 2018: 3 · 2017: 2 · 2016: 1 · 2015: 5 · 2014: 6
- FWCI
- 3.95
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Cardiovascular Diabetology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Japan Diabetes Society
- Topics
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- stable angina, percutaneous coronary intervention, major adverse cardiovascular events, diabetes mellitus, glucose tolerance, revascularization, LDL cholesterol, stroke history, cardiovascular risk factors, Japanese patients, timing of revascularization, myocardial infarction, stroke, cardiovascular mortality
- MeSH terms
- Aged, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Glucose Tolerance Test, Humans, Hyperglycemia, Male, Middle Aged, Retrospective Studies, Multivariate Analysis, Proportional Hazards Models, Treatment Outcome, Glucose Intolerance, Kaplan-Meier Estimate, Angina, Stable, Percutaneous Coronary Intervention
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