Author + information
- Marlies Kok1,
- Clemens von Birgelen1,
- Paolo Zocca2,
- Marc Hartmann1,
- K. Gert van Houwelingen3,
- Martin Stoel1,
- Frits de Man4,
- J.Hans Louwerenburg5,
- Marije Lowik1,
- Gert Kant6,
- Cees Doelman7,
- Gerard C.M. Linssen8,
- Liefke van der Heijden1,
- Carine J.M. Doggen9 and
- Kenneth Tandjung5
- 1Thoraxcentrum Twente, Enschede, Netherlands
- 2Medisch Spectrum Twente, Enschede, Netherlands
- 3Thoraxcentrum Twente, MST Enschede, Enschede, Netherlands
- 4Thoraxcentrum Twente, Medisch Spectrum Twente, ENSCHEDE, Netherlands
- 5Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
- 6Department of Internal Medicine, Medisch Spectrum Twente, Enschede, the Netherlands, Enschede, Netherlands
- 7Department of Clinical Laboratory, Medlon b.v., Medisch Spectrum Twente, Enschede, the Netherlands, Enschede, Netherlands
- 8Ziekenhuis Groep Twente, Almelo and Hengelo, Almelo/Hengelo, Netherlands
- 9Department Health Technology and Services Research, MIRA, University of Twente, Enschede, Enschede, Netherlands
Patients with abnormal glucose metabolism, including patients with undetected and thus untreated diabetes, may have higher event risks after percutaneous coronary intervention (PCI) with contemporary drug-eluting stents (DES). We assessed the prevalence and clinical impact of abnormal glucose metabolism in all-comer patients without previously known diabetes undergoing PCI.
The BIO-RESORT Silent Diabetes study, performed at Thoraxcentrum Twente, is a substudy of the randomized BIO-RESORT trial (NCT01674803). We performed an additional analysis identifying patients with an abnormal glucose metabolism by means of oral glucose tolerance testing (OGTT), and assessment of glycated hemoglobin A1c (HbA1c) with fasting plasma glucose (FPG) and clinical outcome at 12 months.
Assessment of glucose metabolism revealed that of the 988 participants a total 330 (33.4%) patients had an abnormal metabolism, while 658 (66.6%) patients had a normal metabolism. Patients with abnormal glucose metabolism showed higher rates of the primary endpoint Target Vessel Failure (6.4% vs. 2.7%; p<0.01), a composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization. Multivariate analysis demonstrated that an abnormal glucose metabolism independently predicted adverse event risk (HR 2.2, 95%-CI:1.2-4.2).
Abnormal glucose metabolism was detected in one out of three PCI all-comer patients and independently associated with a more than 2-fold higher event risk. Future intervention studies should determine whether meaningful benefits may accrue from routine glycaemia testing in such patients.
CORONARY: PCI Outcomes