Author + information
- Marlies Kok1,
- Clemens Von Birgelen1,
- Paolo Zocca2,
- Marije Lowik1,
- Peter Danse3,
- Carl Schotborgh4,
- Martijn Scholte5,
- Marc Hartmann1,
- Cees Doelman6,
- Gert Kant7,
- R. Melvyn Tjon Joe Gin8,
- Martin Stoel1,
- K. Gert van Houwelingen9,
- Gerard C.M. Linssen10,
- Carine J.M. Doggen11 and
- Liefke van der Heijden1
- 1Thoraxcentrum Twente, Enschede, Netherlands
- 2Medisch Spectrum Twente, Enschede, Netherlands
- 3Rijnstate Hospital, Arnhem, Arnhem, Netherlands
- 4Haga Hospital, The Hague, The Hague, Netherlands
- 5Albert Schweitzer Hospital, Dordrecht, Dordrecht, Netherlands
- 6Department of Clinical Laboratory, Medlon b.v., Medisch Spectrum Twente, Enschede, the Netherlands, Enschede, Netherlands
- 7Department of Internal Medicine, Medisch Spectrum Twente, Enschede, the Netherlands, Enschede, Netherlands
- 8Rijnstate Hospital Arnhem, Arnhem, Netherlands
- 9Thoraxcentrum Twente, MST Enschede, Enschede, Netherlands
- 10Ziekenhuis Groep Twente, Almelo and Hengelo, Almelo/Hengelo, Netherlands
- 11Department Health Technology and Services Research, MIRA, University of Twente, Enschede, Enschede, Netherlands
Prediabetes (Pre-DM) is a risk factor state for developing diabetes mellitus (DM). Yet it is unclear whether detection of Pre-DM by routine assessment of glycated haemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) among patients undergoing percutaneous coronary intervention (PCI) may help identify subjects with increased event risk. We assessed in all-comers who underwent PCI with contemporary drug-eluting stents (DES) the relation between glycaemia status and 1-year clinical outcome.
HbA1c and FPG was determined in 2,362 non-DM participants in the multicenter, randomized, investigator-initiated TWENTE III trial, in order to identify Pre-DM (HbA1c 42-47mmol/mol; FPG 6.1-6.9 mmol/L) and DM (HbA1c≥48mmol/mol; FPG >7 mmol/L). Another 624 patients had medically treated DM. The main clinical outcome parameter was a composite endpoint consisting of death, myocardial infarction, or revascularisation.
Glycaemic state was known in 2,986 trial participants: Pre-DM was present in 324 (11%), DM in 793 (27%), and normoglycaemia in 1,869 (63%) patients. Patients with Pre-DM and DM differed from normoglycemic patients in cardiovascular risk factors. The composite clinical endpoint in Pre-DM occurred in 11.1%, in DM in 10.5%, and in normoglycemic patients in 5.7% (p<0.001). Mortality rates were higher in Pre-DM (3.5%) and DM (3.1%) than in normoglycaemia (1.2%, p=0.001). Patients with Pre-DM had a 2-times higher event risk than normoglycaemic patients (adjusted HR 2.0, 95%CI:1.4-3.0).
Following PCI with contemporary DES, all-comers with Pre-DM had a significantly higher adverse event risks than normoglycemic patients. In non-DM patients who require stenting for obstructive coronary disease, routine assessment of HbA1c and FPG appears be of clinical value to identify subjects with increased event risk.