Prediabetes and coronary artery disease: Outcome after revascularization procedures

ObjectiveTo assess the long-term association between prediabetes and an increased risk of cardiovascular events in patients with coronary artery disease and percutaneous coronary intervention (PCI).MethodsA retrospective cohort study. We searched our database to identify all PCI procedures performed in 2010. Patients with no diabetes and HbA1c measurement in the index hospitalization were enrolled and divided into two groups based on HbA1c value: 5.7–6.5% for prediabetes and <5.7% for controls. Demographic, clinical, and procedure-related variables were recorded. Study endpoints were mortality, hospital admissions, myocardial infarction (MI), and revascularization procedures.ResultsThe study population consisted of 132 subjects (82.6% males, age: 65.26 ± 12.46 years). No difference was found as regards distribution of demographic, clinical, and procedure-related variables. A majority (64.1%) of PCI procedures were performed for ST-segment elevation MI. Prevalence of prediabetes was 40.2%. After a mean follow-up period of 42.3 ± 3.6 months, no differences were found in outcomes between the prediabetes and control groups in total mortality (5.4% vs 1.9%; relative risk [RR] 2.86, 95% confidence interval [95% CI] 0.27–30.44; p = 0.56), non-cardiovascular mortality (2.7% vs 1.9%; RR 1.43, 95% CI 0.93–22.18; p = 0.79), hospital admissions (19% vs 25%; RR 1.13, 95% CI 0.73–1.73; p = 0.57), MI (3% vs 1%; RR 4.28, 95% CI 0.46–39.52; p = 0.30), or target lesion revascularization (3% vs 6%; RR 0.70, 95% CI 0.18–2.61; p = 0.72).ConclusionsPrediabetes, as determined by HbA1c (5.7–6.5%), is not associated with long-term adverse cardiovascular outcomes in patients with CAD and PCI.

ResumenObjetivoDeterminar si la prediabetes, a largo plazo, se asocia a un mayor riesgo de eventos cardiovasculares en pacientes con cardiopatía isquémica y revascularización coronaria percutánea.Método.Cohortes retrospectivo. De los procedimientos de revascularización realizados durante 2010 se seleccionaron aquellos sin diagnóstico de diabetes y con determinación de hemoglobina glucosilada. Se constituyeron 2 grupos: prediabetes (5,7-6,5%) y control (< 5,7%). Se registraron variables demográficas, clínicas e intervencionistas. Los objetivos de estudio fueron mortalidad, ingresos hospitalarios, infarto de miocardio (IM) y procedimientos de revascularización.ResultadosLos sujetos de estudio fueron 132 (hombres 82,6%; edad 65,26 ± 12,46). No se encontraron diferencias significativas en las variables demográficas, clínicas ni intervencionistas. La prevalencia de prediabetes fue 40,2%. El 64,1% de los casos de revascularización se debieron a IM con elevación de ST. Tras un seguimiento de 42,3 ± 3,6 meses no se encontraron diferencias entre prediabetes y control en mortalidad total: 5,4% vs 1,9% (riesgo relativo [RR]: 2,86, intervalo de confianza del 95% [IC 95%]: 0,27-30,44, p = 0,56), mortalidad no cardiovascular: 2,7% vs 1,9% (RR: 1,43, IC 95%: 0,93-22,18, p = 0,79), ingresos de cualquier causa: 19% vs 25% (RR: 1,13, IC 95%: 0,73-1,73, p = 0,57), IM: 3% vs 1% (RR: 4,28, IC 95%: 0,46-39,52; p = 0,30) ni revascularización de la lesión tratada: 3% vs 6% (RR: 0,70, IC 95%: 0,18-2,61, p = 0,72).ConclusionesEn pacientes sometidos a revascularización coronaria la presencia de prediabetes, definida según valores de hemoglobina glucosilada, no se asocia a un incremento de eventos cardiovasculares a largo plazo.