Impact of in-hospital versus ambulatory glucose variability on coronary plaque vulnerability in patients with coronary artery disease

Abstract

Aim: The impact of in-hospital and ambulatory glucose variability (GV) on lipid core plaques (LCP) is unclear. We evaluated the relation of GV during hospitalization and after discharge to LCPs. Methods: A total of 35 patients undergoing percutaneous coronary intervention (PCI) under near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) guidance for acute myocardial infarction (MI) and stable coronary artery disease were prospectively included. LCP was evaluated with a lipid core burden index (LCBI) and a maximum LCBI in 4 mm (max LCBI4mm) in the non-target vessel using NIRS-IVUS. GV was measured by a flush glucose monitoring system. Results: In-hospital mean amplitude of glucose excursion (MAGE) was significantly higher than that after discharge (73.4±26.8 vs. 66.0±22.8 mg/dl, p=0.03). In the entire study population, LCBI and maxLCBI4mm in the non-target vessel were correlated with MAGE after discharge (r=0.51, p=0.002 and r=0.39, p=0.02), but not significantly correlated with in-hospital MAGE. The relations of MAGE to higher LCBI and maxLCBI4mm were more evident in patients with acute MI. Conclusions: GV was greater during hospitalization than after discharge in patients undergoing PCI. Greater GV after discharge was significantly associated with higher LCBI and maxLCBI4mm, suggesting that ambulatory GV may be closely link to coronary atherosclerosis.

Keywords

• Ambulatory glucose variability
• In-hospital glucose variability
• Near-infrared spectroscopy intravascular ultrasound
• Coronary artery disease