Key result
Lower eGDR links to ~34% higher MACCE risk per unit decrease in non-diabetic NSTE-ACS PCI patients.
Why the study?
The usefulness of estimated glucose disposal rate for prognosis in non-diabetic patients with NSTE-ACS after elective PCI is unknown.
Does a lower estimated glucose disposal rate (eGDR) predict major adverse cardio-cerebral events in non-diabetic patients with NSTE-ACS undergoing elective PCI?
Cohort (n=1,510)
No
Does a lower estimated glucose disposal rate (eGDR) predict major adverse cardio-cerebral events in non-diabetic patients with NSTE-ACS undergoing elective PCI?
Hazard Ratio: 1.337 (95% CI 1.201–1.488)
Absolute Event Rate: 25.7% vs 16.1%
p-value: p=<0.001
A low estimated glucose disposal rate (eGDR) is a strong, independent predictor of poor long-term cardiovascular outcomes in non-diabetic patients with NSTE-ACS undergoing PCI, improving risk stratification beyond traditional risk factors.
eGDR was associated with higher MACCE risk in non-diabetic NSTE-ACS post-PCI; leaves open whether it refines stratification in practice.
BACKGROUND: Measurement of estimated glucose disposal rate (eGDR) has been demonstrated to be an indicator of insulin resistance (IR) and a risk sign for long-term outcomes in those with ischemic heart disease and type 2 diabetes mellitus (T2DM) having coronary artery bypass grafting (CABG). After elective percutaneous coronary intervention (PCI), the usefulness of eGDR for prognosis in those with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and non-diabetes is yet unknown. METHODS: 1510 NSTE-ACS patients with non-diabetes who underwent elective PCI in 2015 (Beijing Anzhen Hospital) were included in this study. Major adverse cardio-cerebral events (MACCEs), such as all-cause mortality, non-fatal myocardial infarction, non-fatal ischemic stroke, and also ischemia-driven revascularization, were the main outcome of follow-up. The average number of follow-up months was 41.84. RESULTS: After multivariate Cox regression tests with confounder adjustment, the occurrence of MACCE in the lower eGDR cluster was considerably higher than in the higher eGDR cluster, demonstrating that eGDR is an independent prognostic indicator of MACCEs. In particular, as continuous variate: hazard ratio (HR) of 1.337, 95% confidence interval (CI) of 1.201-1.488, P < 0.001. eGDR improves the predictive power of usual cardiovascular risk factors for the primary endpoint. Specifically, the results for the area under the receiver operating characteristic (ROC) curve, this is AUC, were: baseline model + eGDR 0.699 vs. baseline model 0.588; P for contrast < 0.001; continuous net reclassification improvement (continuous-NRI) = 0.089, P < 0.001; and integrated discrimination improvement (IDI) = 0.017, P < 0.001. CONCLUSION: Low eGDR levels showed a strong correlation with poor NSTE-ACS prognosis for nondiabetic patients undergoing PCI.
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Liu et al. (2022) conducted a cohort in Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) without diabetes (n=1,510). Estimated glucose disposal rate (eGDR) vs. Higher eGDR was evaluated on Major adverse cardio-cerebral events (MACCEs) (HR 1.337, 95% CI 1.201-1.488, p=<0.001). A lower estimated glucose disposal rate was independently associated with an increased risk of major adverse cardio-cerebral events (HR 1.337 per 1-unit decrease) in non-diabetic patients with NSTE-ACS undergoing PCI.
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