Department of Cardiology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, 950-1197, Japan.
Division of Cardiology, Shinrakuen Hospital, 3-3-11 Shindori-minami, Nishi-ku, Niigata, 950-2087, Japan.
Acta Diabetol. 2020 Feb;57(2):173-182. doi: 10.1007/s00592-019-01394-7. Epub 2019 Aug 2.
Practical management guidelines for impaired glucose tolerance (IGT) have not been established. Although IGT is a potent marker of cardiovascular disease (CVD), it is still controversial whether its magnitude of CVD risk is comparable to that of frank diabetes. Moreover, information on long-term clinical outcomes of IGT patients undergoing coronary revascularization is limited. The aim of the present work was to investigate the 10-year prognostic impact of IGT in comparison with diabetes in patients with CAD undergoing coronary revascularization.
This cohort recruited from two Japanese clinical sites included patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) between 2004 and 2008. Patients were categorized into previously known diabetes (PKD, n = 197), newly diagnosed diabetes (NDD, n = 51), and IGT (n = 50) groups according to oral glucose tolerance test results except for PKD. The primary end point was defined as a composite of cardiovascular death, myocardial infarction, stroke, repeat revascularization, and heart failure hospitalization.
The cumulative risk of the primary outcome was significantly higher in the PKD and IGT than in the NDD (log-rank test p = 0.017). A Cox proportional hazards model demonstrated that IGT (hazard ratio [HR], 7.91; 95% confidence interval [CI], 1.84-27.58) and creatinine clearance (HR, 7.89, 95% CI, 2.73-19.10) were predictors of long-term CVD risk, while NDD and PKD were not.
IGT significantly increased the long-term risk of developing CVD in patients with CAD after PCI compared with diabetes.
尚未制定葡萄糖耐量受损（IGT）的实用管理指南。尽管 IGT 是心血管疾病（CVD）的有力标志物，但IGT 的 CVD 风险程度是否与糖尿病相当仍存在争议。此外，关于接受冠状动脉血运重建的 IGT 患者的长期临床结局的信息有限。本研究旨在比较冠状动脉血运重建的 CAD 患者中 IGT 与糖尿病的 10 年预后影响。
该队列研究从两个日本临床站点招募了 2004 年至 2008 年间接受经皮冠状动脉介入治疗（PCI）的冠心病（CAD）患者。根据口服葡萄糖耐量试验结果，患者被分为已知糖尿病（PKD，n=197）、新诊断糖尿病（NDD，n=51）和 IGT（n=50）组，除 PKD 外。主要终点定义为心血管死亡、心肌梗死、卒中和再次血运重建和心力衰竭住院的复合终点。
PKD 和 IGT 的主要结局累积风险明显高于 NDD（对数秩检验，p=0.017）。Cox 比例风险模型表明，IGT（风险比[HR]，7.91；95%置信区间[CI]，1.84-27.58）和肌酐清除率（HR，7.89，95%CI，2.73-19.10）是长期 CVD 风险的预测因素，而 NDD 和 PKD 则不是。
与糖尿病相比，IGT 可显著增加 PCI 后 CAD 患者发生 CVD 的长期风险。
