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Outcomes in prediabetes vs. diabetes in patients with non-ST-segment elevation myocardial infarction undergoing

Yong Hoon Kim1, Ae-Young Her1, Myung Ho Jeong2

  • 1Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon.

Coronary Artery Disease
|October 16, 2020
PubMed

Insights

Prediabetes and diabetes patients with non-ST-elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) undergoing percutaneous coronary intervention (PCI) show similar adverse cardiac events. However, both groups experienced worse outcomes than normoglycemic patients.

Area of Science:

  • Cardiology
  • Endocrinology
  • Interventional Cardiology

Background:

  • Long-term clinical outcomes for patients with prediabetes and diabetes undergoing percutaneous coronary intervention (PCI) for non-ST-elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) are not well-established.
  • Understanding these outcomes is crucial for optimizing treatment strategies in this high-risk population.

Purpose of the Study:

  • To compare the 2-year clinical outcomes of patients with NSTEMI and MVD who underwent PCI, stratified by glycemic status: normoglycemia, prediabetes, and diabetes.
  • To evaluate the incidence of major adverse cardiac events (MACE) and stent thrombosis.

Main Methods:

  • A retrospective analysis of 2963 patients with NSTEMI and MVD who underwent PCI.
  • Patients were categorized into three groups: normoglycemia (n=629), prediabetes (n=802), and diabetes (n=1532).
  • Primary outcomes included MACE (all-cause death, recurrent myocardial infarction [Re-MI], any repeat revascularization); secondary outcome was stent thrombosis (ST).

Main Results:

  • Patients with prediabetes (Group B) and diabetes (Group C) had similar incidences of MACE and death/MI compared to each other.
  • Both prediabetic and diabetic patients exhibited significantly higher MACE rates than normoglycemic patients (Group A).
  • All-cause death was significantly higher in Group B and both all-cause and cardiac death were significantly higher in Group C compared to Group A. No significant differences in adverse outcomes were observed between Groups B and C.

Conclusions:

  • In patients with NSTEMI and MVD treated with newer-generation drug-eluting stents (DES), prediabetes is associated with worse clinical outcomes compared to normoglycemia.
  • The outcomes for prediabetic patients were comparable to those with diabetes, highlighting the significant risk posed by impaired glucose metabolism.
  • These findings underscore the importance of glycemic control and risk stratification in patients undergoing PCI for complex coronary artery disease.
Abstract

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