Elevated Risk of an Intermediate or High SYNTAX Score in Subjects with Impaired Fasting Glucose

Abstract

Objective This study was designed to determine the SYNTAX score under different fasting plasma glucose (FPG) states in Chinese patients undergoing coronary angiography, particularly subjects with impaired FPG. Methods Four hundred and forty-six subjects undergoing coronary angiography were enrolled in this study and divided into four groups based on the FPG level or a history of type 2 diabetes mellitus (T2DM): normal FPG, impaired FPG, known and previously unknown T2DM. Results The angiographic SYNTAX scores were higher in the subjects with known (p<0.001) or previously unknown (p<0.001) T2DM than in those with normal FPG. There were significant differences in the number of diseased coronary artery vessels between the subjects with known (p<0.01) or unknown T2DM (p<0.05) and the subjects with normal FPG. However, there were no significant differences in the SYNTAX score or the number of diseased coronary artery vessels between the subjects with impaired FPG and those with normal FPG. The subjects with impaired FPG (2.917-fold, p=0.004) and known (3.064-fold, p=0.000) or previously unknown (3.301-fold, p=0.000) T2DM exhibited a significantly elevated risk of having an intermediate or high SYNTAX score compared with the subjects with normal FPG. Conclusion Chinese subjects with impaired FPG have a significantly elevated risk of having an intermediate or high SYNTAX score, indicating a risk of severe coronary artery lesions. Subjects with known or previously unknown T2DM may have severe coronary artery lesions. These findings suggest the importance of achieving better glycemic control in order to prevent coronary atherosclerosis and improve the cardiovascular prognosis.

Predictive value of fasting blood glucose for serious coronary atherosclerosis in non-diabetic patients

“…In a study by Karakoyun et al, 4 high FBG and a SYNTAX score >22 were significantly correlated in patients with type 2 DM, while a further study found that either DM or IFG could predict a SYNTAX score >22. 12 However, no association between fasting glucose levels and SYNTAX score >22 was found in nondiabetic patients in a study by Arbel et al 6 Notably, in terms of artery stenosis, the Gensini score starts at 25% occlusion while the SYNTAX score only begins at 50%, suggesting that the Gensini score might be a more sensitive parameter than SYNTAX score for detecting early atherosclerotic coronary artery lesions. Although previous studies demonstrated that hyperglycemia was positively related to Gensini score in non-diabetic patients, [8][9][10][11] whether hyperglycemia was closely correlated with high Gensini score in these patients remained unknown.…”

“…13 These scores, together with several clinical variables, can predict the likelihood of fatal and non-fatal cardiovascular events in patients with CAD. 20 Yang et al 12 demonstrated that SYNTAX scores were higher in subjects with type 2 DM or IFG compared with those with normal FBG. In a study by Karakoyun et al, 4 high FBG and a SYNTAX score >22 were significantly correlated in patients with type 2 DM, while a further study found that either DM or IFG could predict a SYNTAX score >22.…”

“…However, the value of FBG as an independent predictor of serious coronary lesions currently remains unclear. 4,6,12…”

“…However, the value of FBG as an independent predictor of serious coronary lesions currently remains unclear. 4,6,12 This study aimed to investigate the significance of FBG for predicting a Gensini score >41, as a marker of coronary artery lesion severity, in hospitalized patients undergoing coronary angiography.…”

Incidence of Impaired Glucose Tolerance Assessed by Glycated Hemoglobin and Fasting Plasma Glucose in Patients with Acute Coronary Syndromes and its Impact on Clinical and Angiographic Outcomes

“…However, there were no significant differences in the angiographic SYNTAX scores between the subjects with impaired FPG and normal FPG (p>0.05) (25) .…”