Author + information
- Hiroyuki Yamamoto1,
- Toshiro Shinke1,
- Hiromasa Otake2,
- Hiroyuki Kawamori1,
- Yuto Shinkura1,
- Koji Kuroda3,
- Yuichiro Nagano4,
- Takayoshi Toba1,
- Youichirou Sugizaki1,
- Hiroyuki Onishi1 and
- Ken-ichi Hirata5
- 1Kobe University Graduate School of Medicine, Kobe, Japan
- 2Kobe University Graduate School of Medicine, Kobe, Japan, Kobe, Japan
- 3Kobe University Graduate School of Medicine, kobe city, Japan
- 4Kobe University Graduate School of Medicine, Kobe-shi, Japan
- 5Kobe University graduate school of medicine, Kobe City, Japan, Kobe, Japan
Elevated daily glucose fluctuation (GF) was associated with major adverse cardiovascular events (MACE) in patients with acute myocardial infarction. We previously reported mean amplitude glucose excursions (MAGE) as a marker of daily glucose fluctuation affects coronary plaque vulnerability in patients with coronary artery disease (CAD) pre-treated with lipid-lowering therapy. However, the impact of glucose fluctuation on clinical outcome and disease progression in patient with stable angina pectoris (SAP) still remains unclear.
One hundred patients with SAP who were pre-treated with lipid-lowering therapy (low-density lipoprotein cholesterol <120 mg/dl under statins or <100 mg/dl without statins) and referred for percutaneous coronary intervention (PCI) were prospectively enrolled. Glucose fluctuation expressed as MAGE on continuous glucose monitoring system was evaluated before PCI. Quantitative coronary angiographic assessment was performed for non-culprit intermediate lesions (%diameter stenosis between 30% to 70%) at baseline and 12 months later. The primary endpoint was a composite of cardiac death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), and de-novo coronary revascularization during 12 months. The secondary endpoint was the progression of luminal narrowing on non-culprit lesions.
Twenty-four patients experienced the primary endpoint (3 MI, 11 TLR and 13 de-novo revascularization). MAGE was significantly higher in the event group (75.2±23.1mg/dl vs. 59.0±23.5mg/dl, P<0.01). On multiple logistic regression analysis, MAGE was an independent predictor of the composite endpoints (OR: 1.028, 95%C.I: 1.007-1.048; p=0.007). The best cut-off value of MAGE predicting the composite endpoints was 70.7mg/dl (AUC: 0.711 95%C.I: 0.597-0.824, p=0.002). Additionally, MAGE was independently associated with the progression of luminal narrowing in non-culprit lesions (r=0.301, p=0.01). The late loss of lesion diameter was significantly higher in MAGE>70.7mg/dl than low MAGE (0.33±0.41mm vs 0.12±0.27mm). (Figure)
|Univariate and multivariate logistic regression analysis for MACE in patients with stable angina under lipid lowering therapy|
|OR||95% CI||P value||OR||95% CI||P value|
Daily glucose fluctuation may affect future cardiovascular events in patients with SAP pretreated with lipid-lowering therapy.