Prediabetic Patient Outcomes 8 to 15 Years After Drug-Eluting Coronary Stenting

Am J Cardiol. 2021 Jun 15:149:21-26. doi: 10.1016/j.amjcard.2021.03.028. Epub 2021 Mar 20.

Abstract

Guidelines suggest differential management of diabetics and nondiabetics with coronary artery disease (CAD) referred for revascularization, but pre-diabetics, who now comprise up to 20% to 30% of CAD patients, have been excluded from the diabetic group. To address this, we studied long-term cardiac outcomes in 1,323 consecutively drug-eluting stent (DES)-stented patients from prespecified local zip codes, dividing patients into normal-glycemic patients, prediabetics and diabetics, based upon conventional definitions. Patient age was 63±11 years, 65.5% male, mean baseline SYNTAX score of 10.2±6.8 and residual SYNTAX score=3.0±4.6. Only 2.9% of patients were lost to follow up at 10 years. Duration of follow up for alive patients was 124±33 mos. Major adverse cardiac events (MACE) by Kaplan Meier (KM) was similar for normal glycemics and prediabetics (42.9±2.5% vs 38.6±3.1% at 10 years, p=0.35), whereas that for diabetics was worse (56.7±2.6% at 10 years, p<0.001 vs prediabetics). KM cardiac death rates at 10 years were 14.2±1.8%, 16.0±2.4% and 31.2±2.3% for normal glycemics, prediabetics, and diabetics, respectively (p=0.34 and p<0.001 [covariate adjusted p=0.018] for prediabetics versus normal glycemics and versus diabetics, respectively). We found that prediabetics have long-term post-DES outcomes far more similar to those of normal-glycemic patients than diabetics.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Case-Control Studies
  • Comorbidity
  • Coronary Stenosis / epidemiology
  • Coronary Stenosis / surgery*
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / metabolism
  • Drug-Eluting Stents*
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin / metabolism
  • Heart Diseases / mortality*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Mortality
  • Myocardial Infarction / epidemiology*
  • Myocardial Revascularization / statistics & numerical data*
  • Percutaneous Coronary Intervention*
  • Prediabetic State / epidemiology*
  • Prediabetic State / metabolism

Substances

  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human