The Impact of C-Peptide and Diabetes Mellitus on Coronary Ectasia and Effect of Coronary Ectasia and C-Peptide on Long-Term Outcomes: A Retrospective Cohort Study

Abstract

Background. Coronary artery ectasia (CAE) is an entity frequently associated with atherosclerotic coronary artery disease (CAD) in clinical practice. Although it has common risk factors with atherosclerotic CAD in its development, the pathophysiology of CAE is not fully known and it is not seen in every CAD suggesting that different determinants may play a pivotal role in the development of CAD. This study aimed to reveal the impact of C-peptide and diabetes mellitus (DM) on CAE and the effect of C-peptide and coronary ectasia on long-term outcomes in patients who underwent coronary angiography. Methods. A total of 6611 patients who underwent coronary angiography were followed up retrospectively, and their major adverse cardiovascular event (MACE) status of an average of sixty months was recorded. According to their angiographic features, the patients were divided into two groups those with and without CAE. MACE development was accepted as the primary endpoint. Results. A total of 552 patients had CAE and MACE developed in 573 patients. Patients with CAE and higher C-peptide levels (Q4 + Q3) showed higher rates of MACE as compared to those without CAE and lower C-peptide levels (Q1 + Q2) (20.8% vs 7.6%; 70.1% vs 29.1%; p < 0.001 , for both of them). In multivariate regression analysis, high C-peptide levels were determined as an independent risk factor for CAE (OR 2.417; 95% CI 2.212–2.641; p < 0.001 ). The Kaplan–Meier cumulative survival curves showed that the risks for MACE increased as the C-peptide levels increased. The Cox regression analysis for 5-years MACE related to the plasma C-peptide levels and presence of CAE, C-peptide, and CAE were found to be independent predictors of MACE (HR = 1.255, 95% CI: 1.164–1.336, p < 0.001 and HR = 1.012, 95% CI: 1.002–1.023, p = 0.026 , respectively). Conclusion. Our study revealed that a high C-peptide level is an independent risk factor for CAE and that CAE and C-peptide are independent predictors for the development of MACE.

Impact of Platelet-to-HDL-Cholesterol Ratio on Long-Term Mortality in Coronary Artery Disease Patients with or Without Type 2 Diabetes: Insights from a Chinese Multicenter Cohort

“…Results indicated that higher C-peptide levels were independently associated with CAE, and both CAE and C-peptide emerged as independent predictors for major adverse cardiovascular events. 41 Furthermore, Toprak set al assessed the role of HbA1c/ C-peptide ratio (HCR) for high thrombus burden (HTB) and short-term mortality in ST-elevation myocardial infarction (STEMI) patients. HCR was found significantly higher in the HTB group and strongly correlated with short-term mortality, suggesting its potential as a prognostic marker in STEMI patients.…”

Qual a Eficácia do Índice Imune Inflamatório Sistêmico na Etiopatogenia da Ectasia Isolada da Artéria Coronária?

“…A ectasia isolada da artéria coronária (EIAC) é frequentemente encontrada na prática clínica com métodos de imagem invasivos crescentes, e nosso conhecimento sobre sua etiologia, prognóstico e abordagens de tratamento está aumentando diariamente. 1 , 2 Lemos com grande interesse o recente estudo retrospectivo de Dindas et al, 3 que trata da relação entre o Índice de Inflamação Imunológica Sistêmica (IIS) e EIAC. 3 Foi sugerido que neutrófilos, plaquetas e linfócitos IIS coletados em uma única fração podem ser um bom indicador de inflamação e resposta imune.…”

“…Isolated coronary artery ectasia (ICAE) is frequently encountered in clinical practice with increasing invasive imaging methods, and our knowledge about its etiology, prognosis, and treatment approaches is increasing daily. 1 , 2 We read with great interest the recent retrospective study of Dindas et al, 3 which deals with the relationship between the Systemic Immune Inflammation Index (SII) and ICAE. 3 It has been suggested that SII neutrophils, platelets, and lymphocytes collected in a single fraction may be a good indicator of inflammation and immune response.…”