Prediabetic Patient Outcomes 8 to 15 Years After Drug-Eluting Coronary Stenting
Section snippets
Methods
Consecutive patients treated with any limus-eluting drug-eluting stent (DES) from 2004 through 2012 (to allow at least 8 year follow up) from Cuyahoga, Ashtabula or western Geauga counties were identified for follow up from our prospective post-PCI follow up registry. These sites were chosen a priori based upon likely patient follow up within our Health System. Diabetic status at baseline was ascertained by HbA1C and fasting blood sugar levels. Prediabetes was diagnosed using the American
Results
Baseline demographics, angiographic findings and initial treatment details for the 1,323 patients studied are shown in Tables 1, 2 and 3, respectively. There were 468 normal glycemic patients, 328 prediabetics and 502 diabetics (178 of whom required insulin). Twenty-five patients could not be classified for diabetic status with certainty. Findings are notable for patient age of 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
Discussion
The principal finding in this study of nearly 10 year average follow up (and very few lost to follow up) was that prediabetics, in general, had post-DES clinical outcomes very similar to normal glycemic, non-diabetics and clearly superior to patients having diabetes at baseline.
There were, of course, differences in baseline characteristics that might partly explain these findings, including that prediabetics had less advanced coronary disease (e.g., SYNTAX score) and less renal insufficiency
Author Contributions
Stephen G. Ellis: Conceptualization, Analysis, Writing Leslie Cho: Reviewing, Editing Russell Raymond: Reviewing, Editing Ravi Nair: Reviewing, Editing Conrad Simpfendorfer: Reviewing, Editing Murat Tuzcu: Reviewing, Editing Christopher Bajzer: Reviewing, Editing A. Michael Lincoff: Reviewing, Editing Samir Kapadia: Reviewing, Editing.
Disclosure
Regarding potential conflicts of interest, Dr. Ellis has been a consultant for Abbott Vascular, Biotronik, Boston Scientific and Medtronic while Dr. Bajzer is a proctor and speaker for Abbott Vascular. The other authors list no conflicts.
Conflicts of interests
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgments
Special thanks to Georgiana Howell, Kathy Lander, Patrick Vargo and all the nurses and data technicians for maintaining the database from which the report derives, and to Candace Ristagno for assistance with the preparation of this manuscript.
References (17)
- et al.
HbA1c 5•7–6• 4% and impaired fasting plasma glucose for diagnosis of prediabetes and risk of progression to diabetes in Japan (TOPICS 3): a longitudinal cohort study
Lancet
(2011) - et al.
Prediabetes: a high-risk state for diabetes development
Lancet
(2012) - et al.
Silent” diabetes and clinical outcome after treatment with contemporary drug-eluting stents: The BIO-RESORT Silent Diabetes Study
JACC Cardiovasc Interv
(2018) - et al.
Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial
Lancet
(2013) - et al.
Comparison of coronary artery bypass surgery and percutaneous coronary intervention in patients with diabetes: a meta-analysis of randomised controlled trials
Lancet Diabetes Endocrinol
(2013) - et al.
Prognostic value of hemoglobin A1C levels in patients with diabetes mellitus undergoing percutaneous coronary intervention with stent implantation
Am J Cardiol
(2009) Prediabetes diagnosis and treatment: a review
World J Diabetes
(2015)- et al.
Relation of impaired fasting and postload glucose with incident type 2 diabetes in a Dutch population: the Hoorn Study
JAMA
(2001)
Cited by (0)
Funding: This work was supported by internal Cleveland Clinic sources.