Glycemic Variability on Continuous Glucose Monitoring System Predicts Rapid Progression of Non-Culprit Lesions in Patients With Acute Coronary Syndrome

Kataoka, Satoshi; Gohbara, Masaomi; Iwahashi, Noriaki; Sakamaki, Kentaro; Nakatani, Tatsuya; Akiyama, Eiichi; Maejima, Nobuhiko; Tsukahara, Kengo; Hibi, Kiyoshi; Kosuge, Masami; Ebina, Toshiaki; Umemura, Satoshi; Kimura, Kazuo

doi:10.1253/circj.cj-15-0496

Cited by 32 publications

(34 citation statements)

References 33 publications

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“…Therefore, more aggressive treatment including lifestyle modification, 27 intensive lipid-lowering therapy, 28 and aggressive antiplatelet therapy 29 may be required in these patients to suppress coronary plaque vulnerability and to prevent thrombus formation. Given that our group and other investigators reported that MAGE was an independent predictor of plaque rupture at the culprit plaque in patients with AMI, 10 of coronary rapid progression in patients with ACS, 30 and of LV remodeling in patients with AMI, 31 we believe that assessment of MAGE is clinically important in patients with ACS.…”

Section: Grant Supportmentioning

confidence: 70%

Glycemic Variability on Continuous Glucose Monitoring System Correlates With Non-Culprit Vessel Coronary Plaque Vulnerability in Patients With First-Episode Acute Coronary Syndrome　– Optical Coherence Tomography Study –

Gohbara

Hibi

Mitsuhashi

et al. 2016

Circ J

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Section: Grant Supportmentioning

confidence: 70%

Glycemic Variability on Continuous Glucose Monitoring System Correlates With Non-Culprit Vessel Coronary Plaque Vulnerability in Patients With First-Episode Acute Coronary Syndrome　– Optical Coherence Tomography Study –

Gohbara

Hibi

Mitsuhashi

et al. 2016

Circ J

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“…H igh blood glucose levels induced by cortisol produced by stress in acute stroke patients are known to be related to initial neurological severity and poor outcome at 3 months after onset. [1][2][3][4][5][6] However, the detailed dynamic state of blood glucose is affected by various physical conditions and therapeutic processes in the acute phase of stroke, and, accordingly, its association with stroke outcome has not been clarified. Although glycemic variability is known to be associated with the onset of acute coronary syndrome, and hypoglycemia is known to be a predictor of poor outcomes in intensive care unit patients, the relationships between these blood glucose parameters and outcomes are unknown in acute stroke patients.…”

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confidence: 99%

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

Wada

Yoshimura

Inoue

et al. 2018

JAHA

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BackgroundThe purpose of this study was to examine the relationships between glucose parameters obtained by continuous glucose monitoring and clinical outcomes in acute stroke patients.Methods and ResultsConsecutive patients with acute ischemic stroke or intracerebral hemorrhage within 24 hours after onset were included. A continuous glucose monitoring device (iPro2) was attached for the initial 72 hours after emergent admission. Eight glucose parameters were obtained from continuous glucose monitoring: maximum, minimum, mean, and SD of blood glucose levels, as well as area under the curve more than 8 mmol/L of blood glucose, distribution time more than 8 mmol/L of blood glucose, coefficient of variation (%CV), and presence of time less than 4 mmol/L over 72 hours. The primary outcome measure was death or dependency at 3 months (modified Rankin Scale score ≥3). One hundred patients with acute ischemic stroke (n=58) or intracerebral hemorrhage (n=42) were included. Blood glucose levels varied between 5.2±1.4 and 11.4±3.2 mmol/L over 72 hours, with area under the curve more than 8 mmol/L of blood glucose of 0.7±1.4 min×mmol/L, distribution time more than 8 mmol/L of blood glucose of 31.7±32.7%, coefficient of variation of 15.5±5.4%, and presence of hypoglycemia in 20% of overall patients. Mean glucose level (adjusted odds ratio, 1.60, 95% confidence interval, 1.12–2.28/1 mmol/L), area under the curve more than 8 mmol/L of blood glucose (2.13, 1.12–4.02/1 min×mmol/L), and distribution time more than 8 mmol/L of blood glucose (1.25, 1.05–1.50/10%) were related to death or dependency for overall patients, as well as for acute ischemic stroke patients (2.05, 1.15–3.65; 2.38, 1.04–5.44; 1.85, 1.10–3.10, respectively).ConclusionsHigh mean glucose levels, distribution time more than 8 mmol/L of blood glucose, and areas under the curve more than 8 mmol/L of blood glucose during the initial 72 hours of acute stroke were associated with death or dependency at 3 months.

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“…CP during the 5 years after index presentation of ACS and subsequent events: In the present study, disease progression during a mean interval of 7 months between the first and second CAGs was detected in 21.8% of patients presenting with ACS, which is consistent with previous reports that showed that the incidence of stenosis progression in non-culprit lesions was 28% and 23% on repeat angiography at 7 and 11 months, respectively. 12,14) Although several reports have assessed the effect of CP on clinical outcomes, the intervals between serial CAGs were mainly limited to months, [5][6][7] up to a maximum of 2 years. 4) On the other hand, with the exception of our previous report, 10) CP in the late phase has not been investigated.…”

Section: Discussionmentioning

confidence: 99%

“…These variables were selected based on previous studies addressing this issue from a similar clinical perspective. 6,10,[12][13][14] Patients with CP were 1:1 matched to patients without CP based on their propensity score using a caliper of 0.1 of the standard deviation of the logit of the propensity score. For all analyses, P values < 0.05 were considered to indicate statistical significance.…”

Section: Study Populationmentioning

confidence: 99%

Impact of the Temporal Distribution of Coronary Artery Disease Progression on Subsequent Consequences in Patients with Acute Coronary Syndrome

Nakatani¹,

Fukui

Kato

et al. 2019

Int. Heart J.

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The late consequences of acute coronary syndrome (ACS) have been underestimated. We hypothesized that the temporal distribution of the clinically silent coronary artery disease progression (CP) is associated with the subsequent consequences of ACS.We studied 243 patients (202 men, 64 10 years) with ACS undergoing percutaneous coronary intervention (PCI) during initial hospitalization. All patients underwent serial coronary angiograms (CAGs) immediately before PCI and at 7 3 and 60 10 months after presentation. CP was defined as an increase !15% in stenosis severity of the lesion between 2 serial CAGs. The impact of CP between each 2 serial CAGs on subsequent major adverse cardiovascular and cerebrovascular events (MACCEs) after the final CAG was examined using multivariate Cox and propensity-matched analyses.During the median follow-up duration after the final CAG of 67 months, 76 MACCEs (31.3%) were observed. Multivariate Cox proportional hazards analysis revealed that CP between the first and second CAGs (hazard ratio [HR], 2.28; 95% confidence interval [CI], 1.32-3.94; P = 0.003) and CP between the second and final CAGs (HR, 1.96; 95% CI, 1.20-3.21; P = 0.008) were independently associated with a higher rate of MACCEs beyond the final CAG. Consistent results were obtained in the propensity score-matched analyses.CP in both the early (0-7 months) and late phases (7-60 months) were independently associated with subsequent clinical events. This may indicate the prognostic significance of persistent widespread coronary disease activity following presentation in patients with ACS undergoing PCI.(Int Heart J 2019; 60: 287-295)

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Glycemic Variability on Continuous Glucose Monitoring System Predicts Rapid Progression of Non-Culprit Lesions in Patients With Acute Coronary Syndrome

Cited by 32 publications

References 33 publications

Glycemic Variability on Continuous Glucose Monitoring System Correlates With Non-Culprit Vessel Coronary Plaque Vulnerability in Patients With First-Episode Acute Coronary Syndrome　– Optical Coherence Tomography Study –

Glycemic Variability on Continuous Glucose Monitoring System Correlates With Non-Culprit Vessel Coronary Plaque Vulnerability in Patients With First-Episode Acute Coronary Syndrome　– Optical Coherence Tomography Study –

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

Impact of the Temporal Distribution of Coronary Artery Disease Progression on Subsequent Consequences in Patients with Acute Coronary Syndrome

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Glycemic Variability on Continuous Glucose Monitoring System Predicts Rapid Progression of Non-Culprit Lesions in Patients With Acute Coronary Syndrome

Cited by 32 publications

References 33 publications

Glycemic Variability on Continuous Glucose Monitoring System Correlates With Non-Culprit Vessel Coronary Plaque Vulnerability in Patients With First-Episode Acute Coronary Syndrome – Optical Coherence Tomography Study –

Glycemic Variability on Continuous Glucose Monitoring System Correlates With Non-Culprit Vessel Coronary Plaque Vulnerability in Patients With First-Episode Acute Coronary Syndrome – Optical Coherence Tomography Study –

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

Impact of the Temporal Distribution of Coronary Artery Disease Progression on Subsequent Consequences in Patients with Acute Coronary Syndrome

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Product

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Glycemic Variability on Continuous Glucose Monitoring System Correlates With Non-Culprit Vessel Coronary Plaque Vulnerability in Patients With First-Episode Acute Coronary Syndrome　– Optical Coherence Tomography Study –

Glycemic Variability on Continuous Glucose Monitoring System Correlates With Non-Culprit Vessel Coronary Plaque Vulnerability in Patients With First-Episode Acute Coronary Syndrome　– Optical Coherence Tomography Study –