Impact of Hyperinsulinemia on Long-Term Clinical Outcomes of Percutaneous Coronary Intervention in Patients without Diabetes Who Have Acute Myocardial Syndrome

Abstract

Qiang Tan, Ming Chen, Jia Hao, Kun Wei Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, Hebei Province, People’s Republic of ChinaCorrespondence: Qiang TanDepartment of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, No. 258 of Wenhua Road, Qinhuangdao, Hebei Province, 066000, People’s Republic of ChinaEmail [email protected] and Objectives: Hyperinsulinemia plays a key role in the development of cardiovascular impairment in patients with metabolic syndrome. The aim of this study was to evaluate the influence of hyperinsulinemia on long-term clinical outcomes of percutaneous coronary intervention (PCI) in patients without diabetes mellitus who have acute myocardial syndrome (ACS).Methods: Between March 2016 and January 2019, we enrolled 468 patients with ACS and without diabetes mellitus who received primary PCI. Patients were divided into a low-insulin group (n = 157), medium-insulin group (n = 154), and high-insulin group (n = 157) according to tertiles of fasting insulin level. The primary endpoint was major adverse cardiac events (MACE; all-cause death, non-fatal myocardial infarction, target vessel revascularization [TVR]) at 24 months. The secondary endpoint was angina hospitalization.Results: Patients in the high-insulin group had an unfavorable prognosis, with a higher rate of MACE (34.39%) than the low-insulin group (22.29%) and medium-insulin group (23.37%) at 24 months (P < 0.05). This difference was mainly driven by the increase in TVR. The high-insulin group also had a higher rate of angina hospitalization than the low-insulin group. Cox proportional hazards regression showed that high-insulin level (hazard ratio [HR] 1.870, 95% confidence interval [CI] 1.202– 2.909), small-vessel lesion (HR 1.713, 95% CI 1.111– 2.642), bifurcation lesion (HR 3.394, 95% CI 2.033– 5.067), SYNTAX score (HR 1.084, 95% CI 1.039– 1.130), and stent length (HR 1.017, 95% CI 1.002– 1.032) increased the incidence of MACE in patients with ACS and without diabetes who underwent PCI.Conclusion: Hyperinsulinemia might be a valid predictor of clinical outcomes in patients with ACS undergoing PCI.Keywords: percutaneous coronary intervention, hyperinsulinemia, acute myocardial syndrome, major adverse cardiac events

Keywords

• percutaneous coronary intervention
• hyperinsulinemia
• acute myocardial syndrome
• major adverse cardiac events