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Prediabetic Patient Outcomes 8 to 15 Years After Drug-Eluting Coronary Stenting
Stephen G Ellis1, Leslie Cho1, Russell Raymond1
1Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio.
Insights
Pre-diabetic patients with coronary artery disease (CAD) undergoing drug-eluting stent (DES) procedures have similar long-term cardiac outcomes to normal-glycemic individuals, not diabetics. This finding suggests pre-diabetes management in CAD patients may not require the same intensity as diabetes management.
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.
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.
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