Impact of Pre-Diabetes on Coronary Plaque Composition and Clinical Outcome in Patients With Acute Coronary Syndromes : An Analysis From the PROSPECT Study

Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved..

OBJECTIVES: The aim of this study was to investigate the impact of pre-diabetes (pre-DM) on coronary plaque characteristics and ischemic outcomes in patients with acute coronary syndromes (ACS).

BACKGROUND: Pre-DM (i.e., the early stages of glucometabolic disturbance) is common among patients with ACS, but the extent to which pre-DM influences coronary plaque characteristics and the risk for adverse ischemic events is unclear.

METHODS: In the PROSPECT (Providing Regional Observations to Study Predictors of Events in Coronary Tree) study, patients with ACS underwent quantitative coronary angiography, grayscale intravascular ultrasound, and radiofrequency intravascular ultrasound after successful percutaneous coronary intervention. Patients were divided into 3 groups according to their glucometabolic status, as defined by the American Diabetes Association: normal glucose metabolism (NGM), pre-DM, and diabetes mellitus (DM). These groups were compared with regard to coronary plaque characteristics and the risk for major adverse cardiac events (MACEs) (defined as cardiac death or arrest, myocardial infarction, or rehospitalization for unstable or progressive angina).

RESULTS: Among 547 patients, 162 (29.6%) had NGM, 202 (36.9%) had pre-DM, and 183 (33.4%) had DM. There were no significant differences between the groups with regard to intravascular ultrasound findings indicative of vulnerable plaques. Patients with DM had a higher crude rate of MACEs than those with pre-DM or NGM (25.9% vs. 16.3% and 16.1%; p = 0.03 and p = 0.02, respectively). In an adjusted Cox regression model using NGM as the reference group, DM (hazard ratio: 2.20; 95% confidence interval: 1.25 to 3.86; p = 0.006) but not pre-DM (hazard ratio: 1.29; 95% confidence interval: 0.71 to 2.33; p = 0.41) was associated with increased risk for MACEs.

CONCLUSIONS: Impaired glucose metabolism is common among patients presenting with ACS. DM but not pre-DM is associated with an increased risk for MACEs. Thus, preventing patients from progressing from pre-DM to DM is important. (PROSPECT: An Imaging Study in Patients With Unstable Atherosclerotic Lesions; NCT00180466).

Errataetall:

CommentIn: JACC Cardiovasc Imaging. 2019 Apr;12(4):742-744. - PMID 30343078

Medienart:

E-Artikel

Erscheinungsjahr:

2019

Erschienen:

2019

Enthalten in:

Zur Gesamtaufnahme - volume:12

Enthalten in:

JACC. Cardiovascular imaging - 12(2019), 4 vom: 03. Apr., Seite 733-741

Sprache:

Englisch

Beteiligte Personen:

Farhan, Serdar [VerfasserIn]
Redfors, Björn [VerfasserIn]
Maehara, Akiko [VerfasserIn]
McAndrew, Thomas [VerfasserIn]
Ben-Yehuda, Ori [VerfasserIn]
De Bruyne, Bernard [VerfasserIn]
Mehran, Roxana [VerfasserIn]
Giustino, Gennaro [VerfasserIn]
Kirtane, Ajay J [VerfasserIn]
Serruys, Patrick W [VerfasserIn]
Mintz, Gary S [VerfasserIn]
Stone, Gregg W [VerfasserIn]

Links:

Volltext

Themen:

Biomarkers
Blood Glucose
Comparative Study
Coronary artery plaque
Diabetes mellitus
Intravascular ultrasound
Journal Article
Multicenter Study
Pre-diabetes
Research Support, Non-U.S. Gov't

Anmerkungen:

Date Completed 13.01.2020

Date Revised 13.01.2020

published: Print-Electronic

ClinicalTrials.gov: NCT00180466

CommentIn: JACC Cardiovasc Imaging. 2019 Apr;12(4):742-744. - PMID 30343078

Citation Status MEDLINE

doi:

10.1016/j.jcmg.2017.06.023

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM277240255