Abstract Background Diabetes mellitus (DM) is an established risk factor for adverse cardiovascular events in patients with coronary artery disease (CAD). However, the prognostic significance of prediabetes, a condition already characterized by impaired glucose metabolism and early vascular dysfunction, remains largely unclear. Given its potential impact on cardiovascular risk, further investigation into its role in patients undergoing percutaneous coronary intervention (PCI) is needed. Purpose This study aims to assess the prognostic relevance of prediabetes in long-term clinical and interventional outcomes in patients with CAD undergoing PCI. Methods Patients over 18 years of age who underwent PCI between 2010 and 2021 at a tertiary referral center were included in this study. Patients were categorized into three groups based on documented DM diagnosis or HbA1c levels, if DM status was unavailable. The primary endpoint was cardiovascular mortality. Additioal endpoints included MACE (composite of cardiovascular mortality, non-fatal MI, and ischemic stroke/transient ischemic attack) and target lesion failure (TLF; composite of cardiovascular mortality, non-fatal MI, and target lesion revascularization). Results The study cohort included 7,986 patients (65 56-75 years; 73.9% male), of whom 35.0% had no DM, 26.4% had prediabetes, and 38.6% had established DM. During a median follow-up time of 4.5 years, 915 (11.5%) cardiovascular deaths, 2,716 (34.0%) MACE and 2,861 (35.8%) TLF events occurred. Cox regression analysis, adjusted for clinical and demographic variables, demonstrated significantly higher event rates in DM patients compared to those without DM across all endpoints (Table 1). In contrast, prediabetes was not associated with increased adverse event in the total study cohort. Subgroup analysis revealed comparable outcomes for DM and prediabetes compared to those without DM in elective PCI. However, in acute PCI, prediabetes was significantly associated with increased cardiovascular mortality (Figure 1). Conclusion While DM is a strong predictor of adverse clinical and interventional outcomes after PCI, prediabetes appears to be particularly relevant in the setting of acute PCI, where it is associated with increased cardiovascular mortality. This finding suggests that prediabetes may exacerbate cardiovascular vulnerability in acute settings, such as acute coronary syndromes, potentially due to impaired metabolic adaptation and endothelial dysfunction. Recognizing prediabetes as a risk factor in emergency PCI could help refine risk stratification and peri-interventional management strategies.
Steinacher et al. (Sat,) studied this question.