Association of Prediabetes With Higher Coronary Atherosclerotic Burden Among Patients With First Diagnosed Acute Coronary Syndrome

Abstract

Diabetes mellitus (DM) is associated with more extensive coronary atherosclerosis and more vulnerable plaque phenotypes. However, DM should not be considered a homogeneous and purely binary entity in terms of risk assessment. We evaluated the impact of prediabetic status on coronary atherosclerosis burden in patients with first-time acute coronary syndrome (ACS) who underwent urgent coronary angiography. The patients were divided into DM, prediabetes, and control groups. The 3-vessel disease (TVD) rates and SYNTAX and Gensini scoring systems for defining atherosclerotic burden were compared. The study was conducted in 469 consecutive patients admitted with a diagnosis of ACS. Of these, 250 patients were admitted at the first occurrence of ACS undergoing diagnostic coronary angiography. SYNTAX and Gensini scores and TVD rates were higher in prediabetic patients than in nondiabetic patients ( P = .004, P = .008, and P = .014, respectively), but similar in prediabetic and diabetic patients ( P = .912, P = .773, and P = 1.000, respectively). Coronary atherosclerosis burden is more advanced in prediabetic patients than in nondiabetic patients and is comparable between prediabetic and diabetic patients at first presentation of ACS. Cardiologists should not miss the opportunity to diagnose prediabetes and DM when patients present with an ACS.

Correlation between prediabetes and coronary artery disease severity in patients undergoing elective coronary angiography

“…One hundred and seventy-seven patients were prediabetics constituting 24% of the study population. Similar prevalence of prediabetes was demonstrated among elective PCI patients and ACS patients in various registries [11,12]. Patients with prediabetes had the same age range as diabetics and normoglycemic subjects, yet female gender was more prevalent among the diabetic group.…”

“…Nakamura et al [18] demonstrated that among CAD patients, prediabetics and diabetics showed a higher prevalence of dyslipidemia, yet this was evident in postprandial lipid levels and not the fasting lipid levels which are used as the standard screening test. Similarly, Açar et al [12] found no difference in prevalence of dyslipidemia between prediabetic, normoglycemic, and diabetic subjects. The prevalence of CKD was not significantly different among the three groups, although diabetes is known as a common comorbid risk factor for CKD [19] as well as CKD pathophysiology starting in prediabetic subjects [20].…”

“…This is similar to the findings of Santos et al [23] who demonstrated that among patients with CAD confirmed by angiography, prediabetes was more commonly associated with multivessel disease. In addition, Açar et al [12] found that among patients presenting with acute coronary syndrome, diabetic and prediabetic patients showed significantly higher prevalence of three vessel diseases when compared to normoglycemic patients. The complexity of CAD assessed by Gensini score was higher in the prediabetic than in normoglycemic subjects and comparable with diabetics.…”

Admission fasting plasma glucose is associated with in-hospital outcomes in patients with acute coronary syndrome and diabetes: findings from the Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) project

“…Most previous studies have shown that increased HbA 1c or FPG was signi cantly associated with poor in-hospital outcomes in patients with ACS and diabetes. An observational study that included 250 patients with ACS found that coronary atherosclerosis was more advanced in patients with HbA 1c ≥ 5.7% than in those with HbA 1c < 5.7% [17]. Goyal et al [25] conducted a post hoc analysis including two randomized controlled trials of acute myocardial infarction with STsegment elevation, involving 30,536 subjects with diabetes history, and showed that patients with inhospital glucose ≥ 144 mg/dL had a very high risk of death.…”

Non-infarct related chronically occluded coronary arteries and its association with diabetes and prediabetes

“…Atherosclerosis is the leading cause of morbidity and mortality in the industrialized world and diabetes mellitus (DM) magnifi es the risk of cardiovascular events. 1 Whereas "atherosclerosis" is a chronic and progressive process (causing stabile coronary artery disease, SCAD), the rupture of high-risk, vulnerable plaques is responsible for "atherothrombosis" (causing acute coronary syndrome, ACS). 2 Therefore, the presence of atherosclerosis is necessary but not suffi cient for atherothrombosis.…”