Prognostic role of preprocedural glucose levels on short- and long-term outcome in patients undergoing percutaneous coronary revascularization.

OBJECTIVES

We investigated the prognostic role of preprocedural blood glucose levels (BGLs) on short- and long-term outcome in patients undergoing elective percutaneous coronary intervention (PCI).

BACKGROUND

Hyperglycemia and hypoglycemia, with or without pre-existing diabetes mellitus, are associated with adverse outcome in patients with coronary artery disease. Moreover, neointimal hyperplasia after coronary stent implantation is increased in presence of suboptimal glycemic control.

METHODS

Preprocedural BGLs were prospectively measured in 572 patients and predefined groups were considered: hypoglycemia ≤ 80 mg/dl; euglycemia 81-109 mg/dl; mild hyperglycemia 110-125 mg/dl; hyperglycemia ≥ 126 mg/dl. Primary end point was represented by the incidence of peri-procedural myocardial infarction (MI) and secondary end point was the occurrence of major adverse cardiac events (MACE) at follow-up.

RESULTS

Hypoglycemia was associated with an increased risk of peri-procedural MI (51% vs 30%, 29%, and 37% in euglycemia, mild hyperglycemia and hyperglycemia groups, respectively; P for trend 0.025). After a mean follow-up of 15 ± 8 months, the occurrence of MACE was 38% in the hypoglycemia group, 12% in the euglycemia group, 14% in the mild hyperglycemia and 22% in the hyperglycemia group (P < 0.001). The incidence of in-stent restenosis and target vessel revascularization was also higher in patients with abnormal pre-procedural BGLs (P for trend 0.007 and <0.001, respectively). Multivariate analysis confirmed hypoglycemia as a predictor of early and long-term unfavorable cardiac prognosis (OR = 2.53, 95% CI 1.09-5.81, P = 0.029 for peri-procedural MI; OR = 2.91, 95% CI 1.26-6.69, P = 0.012 for MACE occurrence).

CONCLUSIONS

We observed a significant association between preprocedural BGLs and adverse short-and long-term outcome in patients undergoing elective PCI. Thus, a careful glycemic monitoring should be recommended in all patients undergoing coronary stenting, irrespective of the diabetic status.