Three‐year clinical outcome in all‐comers with “silent” diabetes, prediabetes, or normoglycemia, treated with contemporary coronary drug‐eluting stents: From the BIO‐RESORT Silent Diabetes study

Abstract

Background: Patients with coronary disease may have unknown diabetes or prediabetes. We evaluated 3-year outcomes after percutaneous coronary intervention (PCI) with contemporary drug-eluting stents (DES) in patients with silent diabetes, prediabetes, and normoglycemia. Methods: All BIO-RESORT trial (NCT01674803) participants without known diabetes, enrolled at our center, were invited for oral glucose tolerance testing (OGTT) and measurements of fasting plasma glucose and glycated hemoglobin (HbA1c). Results: OGTT detected silent diabetes in 68 (6.9%), prediabetes in 132 (13.4%), and normoglycemia in 788 (79.8%) of all 988 study participants. Follow-up was available in 986 (99.8%) patients. The main endpoint target vessel failure (TVF: cardiac death, target vessel-related myocardial infarction [MI], or target vessel revascularization) differed between groups (14.8, 9.9, and 5.6%; p = .002), driven by MI during the first 48 hr and by cardiac death (p < .001; p = .026). Between 48 hr and 3-years, there was no significant between-group difference in TVF, target vessel MI, and target vessel revascularization. Multivariable analysis demonstrated that silent diabetes was independently associated with TVF (adjusted HR: 2.52, 95%-CI: 1.26-5.03). An alternative diagnostic approach-HbA1c and fasting plasma glucose-detected silent

Impact of prediabetes and diabetes on 3-year outcome of patients treated with new-generation drug-eluting stents in two large-scale randomized clinical trials

“…A previous subgroup analysis of BIO-RESORT assessed 324 patients with prediabetes, 793 with diabetes, and 1869 with normoglycemia and showed that patients with prediabetes, similar to patients with diabetes, had higher 1-year risks of mortality and repeat revascularization after treatment with contemporary DES [ 4 ]. Furthermore, the BIO-RESORT Silent Diabetes study [ 24 ] previously reported that patients with prediabetes and silent diabetes—assessed by oral glucose tolerance testing and HbA1c at the time of the index procedure—had a higher 3-year risk of TVF. Yet, this was mainly driven by events during the first 48 h. Those previously reported data and the findings of the present study suggest that patients with prediabetes have an increased risk of ischemic events.…”

Comparing the Prognostic Impact of Prediabetes with Diabetes in a Nationwide Cohort of Patients with Chronic Coronary Syndromes: An Analysis of the START Registry

“…Previous studies have shown that patients with pre-DM can suffer from CHD even before progressing to overt diabetes [20]. The recent BIO-RESORT Silent Diabetes study [21], which enrolled a cohort of acute and chronic CHD patients categorized as silent DM, pre-DM, and normoglycemia, showed that 3 years after PCI with contemporary DES, pre-DM patients had higher rates of adverse clinical events than patients with normoglycemia. However, a landmark analysis revealed that the aforementioned differences in clinical endpoints at 3-year follow-up were mainly based on events that had occurred during the first 48 h, driven by a higher rate of periprocedural MI [21].…”

“…The recent BIO-RESORT Silent Diabetes study [21], which enrolled a cohort of acute and chronic CHD patients categorized as silent DM, pre-DM, and normoglycemia, showed that 3 years after PCI with contemporary DES, pre-DM patients had higher rates of adverse clinical events than patients with normoglycemia. However, a landmark analysis revealed that the aforementioned differences in clinical endpoints at 3-year follow-up were mainly based on events that had occurred during the first 48 h, driven by a higher rate of periprocedural MI [21]. In line with these and our results, the ARTEMIS (Innovation to Reduce Cardiovascular Complications of Diabetes at the Intersection) study concluded that the risk of cardiac events does not differ between patients with CHD plus pre-DM who have undergone revascularization or OMT and those with normal glycemic status [5].…”

Glycaemic Control in Patients Undergoing Percutaneous Coronary Intervention: What Is the Role for the Novel Antidiabetic Agents? A Comprehensive Review of Basic Science and Clinical Data

“…Xia et al reported that high GV correlated with an increased incidence of troponin release after PCI [72]. More recently, patients with an abnormal glucose metabolism detected by oral glucose tolerance testing documented a higher incidence of myocardial infarction and cardiac death within 48 h after PCI [73].…”