Journal of Diabetes Investigation (Jun 2021)

Impact of daily glucose fluctuations on cardiovascular outcomes after percutaneous coronary intervention for patients with stable coronary artery disease undergoing lipid‐lowering therapy

  • Hiroyuki Yamamoto,
  • Toshiro Shinke,
  • Hiromasa Otake,
  • Hiroyuki Kawamori,
  • Takayoshi Toba,
  • Masaru Kuroda,
  • Yushi Hirota,
  • Kazuhiko Sakaguchi,
  • Wataru Ogawa,
  • Ken‐ichi Hirata

DOI
https://doi.org/10.1111/jdi.13448
Journal volume & issue
Vol. 12, no. 6
pp. 1015 – 1024

Abstract

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Abstract Aims/Introduction Glucose fluctuation (GF) is a residual risk factor for coronary artery disease (CAD). We investigated whether GF influenced clinical outcomes and progression of coronary stenosis in stable CAD patients. Materials and Methods In this prospective study, 101 consecutive lipid‐controlled stable CAD patients underwent percutaneous coronary intervention were enrolled, and GF was expressed as the mean amplitude of glycemic excursion (MAGE) obtained by continuous glucose monitoring before the procedure was evaluated. At 9 months after enrollment, culprit and non‐culprit (mild‐to‐moderate stenosis without ischemia) lesions were serially assessed by angiography. Cardiovascular events (CVE) consisting of cardiovascular death, non‐fatal myocardial infarction or ischemia‐driven revascularization during 2‐year follow up, rapid progression in non‐culprit lesions (defined as ≥10% luminal narrowing progression in lesions with stenosis ≥50%, ≥30% luminal narrowing progression in non‐culprit lesions with stenosis <50% or normal segment, or progression to total occlusion) were evaluated. Results CVE occurred in 25 patients, and MAGE was significantly higher in the CVE group (76.1 ± 24.8 mg/dL vs 59.3 ± 23.7 mg/dL; P = 0.003). Multivariate analysis showed that MAGE was an independent predictor of CVE (odds ratio 1.027, 95% confidence interval 1.008–1.047; P = 0.005). The optimal MAGE value to predict CVE was 70.7 mg/dL (area under the curve 0.687, 95% confidence interval 0.572–0.802; P = 0.005). Furthermore, MAGE was independently associated with rapid progression, and with the luminal narrowing progression in all non‐culprit lesions (r = 0.400, P < 0.05). Conclusions Daily GF might influence future CVE in lipid‐controlled stable CAD patients.

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