Estimated glucose disposal rate and the risk of major adverse cardio-cerebrovascular outcomes and mortality in patients undergoing percutaneous coronary intervention: a retrospective cohort study.

BACKGROUND

While percutaneous coronary intervention (PCI) has improved survival rates, many patients remain at risk for future adverse cardio-cerebral events. This study explores the role of insulin resistance, measured by the estimated glucose disposal rate (eGDR), as a potential predictor of cardio-cerebrovascular outcomes and mortality.

METHODS

This retrospective analysis included patients who underwent PCI at our center between 2015 and 2020. Patients were categorized by glycemic status into individuals with diabetes (DM), pre-DM and normal glucose levels. Our primary outcome was major adverse cardiac and cerebrovascular event (MACCE).

RESULTS

We included 2144 patients-236 patients with pre-DM, 1735 with DM, and 173 with normal glucose levels. After a mean follow-up of 550 days, patients with pre-DM in the Q3 and Q4 quartiles of eGDR were less likely to experience MACCE (HR: 0.172, 95% CI 0.036-0.813 and HR: 0.096, 95% CI 0.013-0.713, respectively). In the DM and non-DM groups, there was no significant relationship between eGDR and MACCE. After adjustment for lipid profile and history of statin medication, results remained consistent for both Q3 and Q4 in pre-DM subgroup with lower rate of MACCE (HR: 0.168, 95% CI 0.033-0.820) and (HR: 0.099, 95% CI 0.012-0.814). Additionally, the Q4 compared to Q1 in the non-DM group demonstrated significantly lower MACCE (HR: 0.000, 95% CI 0.000-0.759).

CONCLUSIONS

Our findings suggest that eGDR could be an important tool for assessing risk for future cardio-cerebral events and mortality in patients with pre-DM and normal glycemic levels who undergo PCI. However, its predictive power in patients with DM appears to be limited.