Key result
Higher glycemic excursion amplitude is linked to ~3% greater cardiovascular event risk in stable CAD.
Why the study?
Glucose fluctuation is a residual risk factor for coronary artery disease, but its influence on clinical outcomes and coronary stenosis progression in stable CAD patients was unclear.
Does glucose fluctuation predict cardiovascular events and coronary stenosis progression in lipid-controlled stable CAD patients undergoing PCI?
Cohort (n=101)
Does glucose fluctuation predict cardiovascular events and coronary stenosis progression in lipid-controlled stable CAD patients undergoing PCI?
Daily glucose fluctuations independently predict future cardiovascular events and rapid progression of non-culprit lesions in lipid-controlled stable CAD patients undergoing PCI.
Higher MAGE may identify elevated CVE and lesion progression risk in lipid-controlled stable CAD post-PCI; leaves open whether targeting fluctuations improves outcomes.
AIMS/INTRODUCTION: Glucose fluctuation (GF) is a residual risk factor for coronary artery disease (CAD). We investigated whether GF influenced clinical outcomes and progression of coronary stenosis in stable CAD patients. MATERIALS AND METHODS: In this prospective study, 101 consecutive lipid-controlled stable CAD patients underwent percutaneous coronary intervention were enrolled, and GF was expressed as the mean amplitude of glycemic excursion (MAGE) obtained by continuous glucose monitoring before the procedure was evaluated. At 9 months after enrollment, culprit and non-culprit (mild-to-moderate stenosis without ischemia) lesions were serially assessed by angiography. Cardiovascular events (CVE) consisting of cardiovascular death, non-fatal myocardial infarction or ischemia-driven revascularization during 2-year follow up, rapid progression in non-culprit lesions (defined as ≥10% luminal narrowing progression in lesions with stenosis ≥50%, ≥30% luminal narrowing progression in non-culprit lesions with stenosis <50% or normal segment, or progression to total occlusion) were evaluated. RESULTS: CVE occurred in 25 patients, and MAGE was significantly higher in the CVE group (76.1 ± 24.8 mg/dL vs 59.3 ± 23.7 mg/dL; P = 0.003). Multivariate analysis showed that MAGE was an independent predictor of CVE (odds ratio 1.027, 95% confidence interval 1.008-1.047; P = 0.005). The optimal MAGE value to predict CVE was 70.7 mg/dL (area under the curve 0.687, 95% confidence interval 0.572-0.802; P = 0.005). Furthermore, MAGE was independently associated with rapid progression, and with the luminal narrowing progression in all non-culprit lesions (r = 0.400, P < 0.05). CONCLUSIONS: Daily GF might influence future CVE in lipid-controlled stable CAD patients.
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Yamamoto et al. (2020) conducted a cohort in stable coronary artery disease (n=101). Glucose fluctuation (mean amplitude of glycemic excursion) was evaluated on Cardiovascular events (cardiovascular death, non-fatal myocardial infarction or ischemia-driven revascularization) (OR 1.027, 95% CI 1.008-1.047, p=0.005). Higher mean amplitude of glycemic excursion was an independent predictor of cardiovascular events in lipid-controlled stable CAD patients (OR 1.027; 95% CI 1.008-1.047; P=0.005).
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