Abnormal glucose metabolism may be present in patients with undetected diabetes after percutaneous coronary intervention (PCI) with contemporary drug-eluting stents (DES) and is associated with a higher event risk and worse clinical outcomes, according to a study in JACC: Cardiovascular Interventions.
To determine the effect of undetected and untreated (silent) diabetes on event risks after PCI with DES, researchers performed oral glucose tolerance testing (OGTT) and an assessment of glycated hemoglobin A1c (HbA1c) with fasting plasma glucose (FPG) in 988 patients undergoing PCI procedures with DES.
The primary end point of the study was a composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization at 1 year.
According to the OGTT, 68 patients had silent diabetes, 133 had prediabetes, and 788 had normal glucose metabolism, and patients with silent diabetes had a higher primary end point rate (13.2% vs 7.6% vs 4.8%, respectively, P <.001) that was mainly attributed to myocardial infarction less than 48 hours after the procedure.
Based on HbA1c and FPG, 33 patients had silent diabetes, 217 patients had prediabetes, and 738 patients had normal glucose metabolism with similar primary end point rates (12.1% vs 5.5% vs 3.1%, respectively; P =.01).
Overall, abnormal glucose metabolism was detected in 33% of patients and was independently associated with a significantly higher risk for reaching the primary composite end point target vessel failure at 1 year. Patients with silent diabetes had up to 4-fold higher risks.
This was the first large-scale study to use OGTT in a population of patients with silent diabetes who underwent PCI with DES and demonstrated the importance of silent diabetes and prediabetes on post-PCI clinical outcomes (ClinicalTrials.gov identifier: NCT01674803). The investigators concluded that “screening for abnormal glucose metabolism among PCI-patients without previously known diabetes is advisable, as it allows identifying subjects at an increased event risk.”
Disclosure: This work was supported by equal funding from Biotronik, Boston Scientific, and Medtronic. Clemens von Birgelen, MD PhD, reports institutional research grants from Biotronik, Boston Scientific, and Medtronic. Naveed Sattar, MD PhD, reports personal fees from Boehringer Ingelheim, Novo Nordisk, Eli-Lilly and Janssen, and grants and personal fees from AstraZeneca.
von Birgelen C, Kok MM, Sattar N, et al. ‘Silent’ diabetes and clinical outcome after treatment with contemporary drug-eluting stents: BIO-RESORT silent diabetes study [published online February 8, 2018]. JACC: Cardiovascular Intervention. doi:10.1016/j.jcin.2017.10.038