Predictors of 12-Month MACE Among Diabetic, Prediabetic, and Normoglycemic Patients Undergoing Elective Percutaneous...

Elevated blood glucose levels in diabetes and prediabetes contribute to vascular inflammation and may increase the risk of major adverse cardiac events (MACE). We sought to evaluate the association between different glycemic statuses and 12-month MACE in patients undergoing elective percutaneous coronary intervention (PCI) at Tehran Heart Center.

In this cohort study, patients who underwent elective PCI between 2008 and 2017 were stratified by preprocedural fasting blood glucose into normoglycemic, prediabetic, and diabetic groups. The primary endpoint was the 1-year incidence of MACE, assessed using unadjusted and adjusted regression models.

The data of 10,797 patients (mean age = 64 ± 11 y; 64.6% men) were reviewed. The diabetic patients were not only older (p < 0.001) and more frequently female (p < 0.001) but also had higher frequencies of hypertension (p < 0.001), using antiplatelet drugs (p < 0.001), statin (p < 0.001), and presence of dyslipidemia (p < 0.001), as well as more stenotic vessels (p = 0.007) and B2/C lesions (p = 0.033) than the other two groups. In addition, regression model demonstrated that neither prediabetes nor diabetes was significantly associated with the risk of 12-month MACE in both unadjusted (hazard ratio [HR]: 1.15, 95% confidence interval [95% CI]: 0.84-1.58; and HR: 1.27, 95% CI: 0.96-1.70, respectively) and adjusted models (HR: 1.19, 95% CI: 0.86-1.66; and HR: 1.11, 95% CI: 0.81-1.52, respectively). Consistently, Kaplan-Meier survival analysis revealed a gradual increase in cumulative MACE incidences across all glycemic categories over 12 months, with the highest event rate observed among diabetic patients; however, these differences were not statistically significant.

Prediabetes and diabetes were not significant predictors of 12-month MACE in our study population. These findings suggest that glycemic status alone may not be sufficient to stratify cardiovascular risk in patients undergoing elective PCI. Further research is warranted to validate these results and explore additional factors influencing MACE incidence in this context.