Author + information
- Received March 30, 2017
- Revision received June 19, 2017
- Accepted June 28, 2017
- Published online October 17, 2018.
- Serdar Farhan, MDa,
- Björn Redfors, MD, PhDb,
- Akiko Maehara, MDb,c,∗ (, )
- Thomas McAndrew, PhDb,
- Ori Ben-Yehuda, MDb,c,
- Bernard De Bruyne, MDd,
- Roxana Mehran, MDa,b,
- Gennaro Giustino, MDa,
- Ajay J. Kirtane, MD, SMb,c,
- Patrick W. Serruys, MD, PhDe,
- Gary S. Mintz, MDb and
- Gregg W. Stone, MDb,c
- aThe Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- bClinical Trials Center, Cardiovascular Research Foundation, New York, New York
- cNewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
- dThe Cardiovascular Center Aalst, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium
- eErasmus University Medical Center, Thoraxcenter, Rotterdam, the Netherlands
- ↵∗Address for correspondence:
Dr. Akiko Maehara, Cardiovascular Research Foundation/Columbia University Medical Center, 1700 Broadway, 9th Floor, New York, New York 10019.
Objectives The aim of this study was to investigate the impact of pre-diabetes (pre-DM) on coronary plaque characteristics and ischemic outcomes in patients with acute coronary syndromes (ACS).
Background Pre-DM (i.e., the early stages of glucometabolic disturbance) is common among patients with ACS, but the extent to which pre-DM influences coronary plaque characteristics and the risk for adverse ischemic events is unclear.
Methods In the PROSPECT (Providing Regional Observations to Study Predictors of Events in Coronary Tree) study, patients with ACS underwent quantitative coronary angiography, grayscale intravascular ultrasound, and radiofrequency intravascular ultrasound after successful percutaneous coronary intervention. Patients were divided into 3 groups according to their glucometabolic status, as defined by the American Diabetes Association: normal glucose metabolism (NGM), pre-DM, and diabetes mellitus (DM). These groups were compared with regard to coronary plaque characteristics and the risk for major adverse cardiac events (MACEs) (defined as cardiac death or arrest, myocardial infarction, or rehospitalization for unstable or progressive angina).
Results Among 547 patients, 162 (29.6%) had NGM, 202 (36.9%) had pre-DM, and 183 (33.4%) had DM. There were no significant differences between the groups with regard to intravascular ultrasound findings indicative of vulnerable plaques. Patients with DM had a higher crude rate of MACEs than those with pre-DM or NGM (25.9% vs. 16.3% and 16.1%; p = 0.03 and p = 0.02, respectively). In an adjusted Cox regression model using NGM as the reference group, DM (hazard ratio: 2.20; 95% confidence interval: 1.25 to 3.86; p = 0.006) but not pre-DM (hazard ratio: 1.29; 95% confidence interval: 0.71 to 2.33; p = 0.41) was associated with increased risk for MACEs.
Conclusions Impaired glucose metabolism is common among patients presenting with ACS. DM but not pre-DM is associated with an increased risk for MACEs. Thus, preventing patients from progressing from pre-DM to DM is important. (PROSPECT: An Imaging Study in Patients With Unstable Atherosclerotic Lesions; NCT00180466)
Dr. Maehara has received grant support from Boston Scientific and St. Jude Medical, is a consultant for Boston Scientific and OCT Medical Imaging, and has received speaking fees from St. Jude Medical. Dr. de Bruyne has received institutional grant support and consulting fees from St. Jude Medical. Dr. Mehran has received institutional research grant support from Eli Lilly/Daiichi Sankyo, Bristol-Myers Squibb, AstraZeneca, The Medicines Company, OrbusNeich, Bayer, CSL Behring, Abbott Laboratories, Watermark Research Partners, Novartis Pharmaceuticals, Medtronic, AUM Cardiovascular, and Beth Israel Deaconess Medical Center; is a member of executive committees for Janssen Pharmaceuticals and Osprey Medical; is a member of the data safety monitoring board of Watermark Research Partners; is a consultant for Medscape, The Medicines Company, Boston Scientific, Merck & Company, Cardiovascular Systems, Sanofi USA, Shanghai BraccoSine Pharmaceutical, and AstraZeneca; and holds equity in Claret Medical and Elixir Medical Corporation. Dr. Kirtane has received institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, and Eli Lilly. Dr. Serruys is a consultant for Abbott Laboratories, AstraZeneca Pharmaceuticals, Biotronik, Cardialysis, GLG Research, Medtronic, Sino Medical Sciences Technology, Tianjin China, Société Europa Digital & Publishing, Stentys France, Svelte Medical Systems, Volcano Europe, and Q3 Medical Devices. Dr. Mintz is a consultant for Boston Scientific and ACIST; has received fellowship and grant support from Volcano, Boston Scientific, and InfraReDx; and has received honoraria from Boston Scientific and ACIST. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Farhan and Redfors contributed equally to this work. David Moliterno, MD, served as the Guest Editor for this paper.
- Received March 30, 2017.
- Revision received June 19, 2017.
- Accepted June 28, 2017.
- 2018 American College of Cardiology Foundation
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