Premium
Three‐year clinical outcome in all‐comers with “silent” diabetes, prediabetes, or normoglycemia, treated with contemporary coronary drug‐eluting stents: From the BIO‐RESORT Silent Diabetes study
Author(s) -
Ploumen Eline H.,
Buiten Rosaly A.,
Kok Marlies M.,
Doggen Carine J.M.,
Houwelingen K. Gert,
Stoel Martin G.,
Man Frits H.A.F.,
Hartmann Marc,
Zocca Paolo,
Linssen Gerard C.M.,
Doelman Cees,
Kant Gert D.,
Birgelen Clemens
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28536
Subject(s) - medicine , prediabetes , conventional pci , percutaneous coronary intervention , diabetes mellitus , cardiology , myocardial infarction , glycated hemoglobin , revascularization , impaired glucose tolerance , impaired fasting glucose , coronary artery disease , type 2 diabetes , endocrinology
Background Patients with coronary disease may have unknown diabetes or prediabetes. We evaluated 3‐year outcomes after percutaneous coronary intervention (PCI) with contemporary drug‐eluting stents (DES) in patients with silent diabetes, prediabetes, and normoglycemia. Methods All BIO‐RESORT trial ( NCT01674803 ) participants without known diabetes, enrolled at our center, were invited for oral glucose tolerance testing (OGTT) and measurements of fasting plasma glucose and glycated hemoglobin (HbA1c). Results OGTT detected silent diabetes in 68 (6.9%), prediabetes in 132 (13.4%), and normoglycemia in 788 (79.8%) of all 988 study participants. Follow‐up was available in 986 (99.8%) patients. The main endpoint target vessel failure (TVF: cardiac death, target vessel‐related myocardial infarction [MI], or target vessel revascularization) differed between groups (14.8, 9.9, and 5.6%; p = .002), driven by MI during the first 48 hr and by cardiac death ( p < .001; p = .026). Between 48 hr and 3‐years, there was no significant between‐group difference in TVF, target vessel MI, and target vessel revascularization. Multivariable analysis demonstrated that silent diabetes was independently associated with TVF (adjusted HR: 2.52, 95%‐CI: 1.26–5.03). An alternative diagnostic approach—HbA1c and fasting plasma glucose—detected silent diabetes and prediabetes in 33 (3.3%) and 217 (22.0%) patients, and normoglycemia in 738 (74.7%); TVF rates were 12.1, 7.9, and 6.0% ( p = .23). Conclusion In patients without known diabetes, abnormal glucose metabolism by OGTT was independently associated with higher 3‐year TVF rates after PCI with contemporary DES. This difference was driven by periprocedural MI and cardiac death. After the first 48 hr, the rates of TVF, target vessel MI, and target vessel revascularization were low and did not differ significantly between metabolic groups.