Prognostic role of preprocedural glucose levels on short- and long-term outcome in patients undergoing percutaneous coronary revascularization

摘要

Objectives: We investigated the prognostic role of preprocedural blood glucose levels (BGLs) on short- and long-term outcome in patients undergoing elective percutaneous coronary intervention (PCI). Background: Hyperglycemia and hypoglycemia, with or without pre-existing diabetes mellitus, are associated with adverse outcome in patients with coronary artery disease. Moreover, neointimal hyperplasia after coronary stent implantation is increased in presence of suboptimal glycemic control. Methods: Preprocedural BGLs were prospectively measured in 572 patients and predefined groups were considered: hypoglycemia ≤ 80 mg/dl; euglycemia 81-109 mg/dl; mild hyperglycemia 110-125 mg/dl; hyperglycemia a;circyen 126 mg/dl. Primary end point was represented by the incidence of peri-procedural myocardial infarction (MI) and secondary end point was the occurrence of major adverse cardiac events (MACE) at follow-up. Results: Hypoglycemia was associated with an increased risk of peri-procedural MI (51% vs 30%, 29%, and 37% in euglycemia, mild hyperglycemia and hyperglycemia groups, respectively; P for trend 0.025). After a mean follow-up of 15 × 8 months, the occurrence of MACE was 38% in the hypoglycemia group, 12% in the euglycemia group, 14% in the mild hyperglycemia and 22% in the hyperglycemia group (P < 0.001). The incidence of in-stent restenosis and target vessel revascularization was also higher in patients with abnormal pre-procedural BGLs (P for trend 0.007 and <0.001, respectively). Multivariate analysis confirmed hypoglycemia as a predictor of early and long-term unfavorable cardiac prognosis (OR = 2.53, 95% CI 1.09-5.81, P = 0.029 for peri-procedural MI; OR = 2.91, 95% CI 1.26-6.69, P = 0.012 for MACE occurrence). Conclusions: We observed a significant association between preprocedural BGLs and adverse short-and long-term outcome in patients undergoing elective PCI. Thus, a careful glycemic monitoring should be recommended in all patients undergoing coronary stenting, irrespective of the diabetic status.