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

Area of Science:

• Cardiology
• Endocrinology
• Public Health

Background:

• Current guidelines differentiate management for diabetics and non-diabetics with coronary artery disease (CAD).
• Pre-diabetic individuals, representing 20-30% of CAD patients, have been historically excluded from diabetic management protocols.
• This exclusion creates a gap in understanding long-term outcomes for this significant patient subgroup.

Purpose of the Study:

• To investigate and compare the long-term cardiac outcomes of drug-eluting stent (DES)-treated patients categorized as normal-glycemic, pre-diabetic, and diabetic.
• To determine if pre-diabetic patients exhibit distinct cardiac event rates compared to both normal-glycemic and diabetic populations post-revascularization.

Main Methods:

• A cohort of 1,323 consecutively drug-eluting stent (DES)-stented patients were classified into normal-glycemic, pre-diabetic, and diabetic groups based on standard definitions.
• Long-term cardiac outcomes, including major adverse cardiac events (MACE) and cardiac death, were assessed over a median follow-up of 10 years.
• Kaplan-Meier analysis was employed to compare event rates between the glycemic groups, with covariate adjustments where appropriate.

Main Results:

• Major adverse cardiac events (MACE) at 10 years were similar between normal-glycemic (42.9±2.5%) and pre-diabetic (38.6±3.1%) patients (p=0.35).
• Diabetic patients experienced significantly worse MACE rates (56.7±2.6%) compared to pre-diabetics (p<0.001).
• Ten-year cardiac death rates were 14.2±1.8% (normal-glycemic), 16.0±2.4% (pre-diabetic), and 31.2±2.3% (diabetic), with pre-diabetics showing outcomes closer to normal-glycemics.

Conclusions:

• Pre-diabetic patients undergoing DES implantation demonstrate long-term cardiac outcomes that are significantly more similar to normal-glycemic individuals than to diabetic patients.
• These findings suggest that current management strategies for CAD patients may need re-evaluation regarding the pre-diabetic subgroup.
• The study highlights the importance of stratifying pre-diabetics separately from diabetics for risk assessment and treatment planning in CAD.