Key result
Silent diabetes detected by OGTT was independently associated with higher 3-year target vessel failure after PCI compared to normoglycemia (14.8% vs 5.6%; adjusted HR 2.52; 95% CI 1.26-5.03).
Why the study?
Patients with coronary disease may have unknown diabetes or prediabetes, and their outcomes after PCI with contemporary DES needed evaluation.
Does silent diabetes or prediabetes increase the risk of target vessel failure in patients without known diabetes undergoing PCI with contemporary DES?
Cohort (n=988)
No
Does silent diabetes or prediabetes increase the risk of target vessel failure in patients without known diabetes undergoing PCI with contemporary DES?
Hazard Ratio: 2.52 (95% CI 1.26–5.03)
Absolute Event Rate: 14.8% vs 5.6%
p-value: p=0.002
In patients without known diabetes undergoing PCI, abnormal glucose metabolism detected by OGTT is independently associated with a higher risk of 3-year target vessel failure, driven primarily by periprocedural MI and cardiac death.
May support OGTT screening in nondiabetic PCI patients; leaves open whether treating silent diabetes reduces target vessel failure.
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.
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Ploumen et al. (2019) conducted a cohort in Coronary disease without known diabetes (n=988). Silent diabetes (detected by OGTT) vs. Normoglycemia was evaluated on Target vessel failure (cardiac death, target vessel-related MI, or target vessel revascularization) (adjusted HR 2.52, 95% CI 1.26-5.03, p=0.002). Silent diabetes detected by OGTT was independently associated with higher 3-year target vessel failure after PCI compared to normoglycemia (14.8% vs 5.6%; adjusted HR 2.52; 95% CI 1.26-5.03).
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