Prediabetes is Associated with Worse Long-Term Outcomes in Young Patients with Acute Coronary Syndrome

Figures & data

Figure 1 Study flow chart.

Abbreviations: NMG, normal metabolism glucose; pre-DM, prediabetes; DM, diabetes mellitus; ACS, acute coronary syndrome; PCI, percutaneous coronary intervention; CABG, Coronary Angioplasty Bypass Grafting; OMI, old myocardial infarction.

Table 1 Baseline Characteristics of Patients According to Glucose or HbA1c on Admission

Variables	NMG	Pre-DM	DM	P
	(n=511)	(n=301)	(n=301)
Clinical variables
Age, y	41.0(37.0,43.6)	41.8(38,44)	42(38.8,43.9)	0.017
Male, n (%)	484(94.7)	291(96.7)	270(89.7)	0.010
BMI (kg/m2)	27.8±3.1	28.3±3.4	28.4±3.3	0.008
Family history of CAD, n (%)	112(21.9)	56(18.6)	69(22.9)	0.388
Hypertension, n (%)	267(52.3)	147(48.8)	190(63.1)	0.001
Dyslipidemia, n (%)	295(57.7)	206(68.4)	210(69.8)	<0.001
Current smoking, n (%)	371(72.6)	218(72.4)	207(68.8)	0.465
Prior cerebral infraction, n (%)	12(1.3)	12(4.0)	19(6.3)	0.018
SBP (mm Hg)	130(120,143)	132(120,145)	135(124,147)	0.008
DBP (mm Hg)	80(70,90)	80(71,90)	83(75,93)	0.004
Heart rate	71(64,80)	74(67,82)	77(70,87)	<0.001
LVEF (%)	60(54,63)	57(50,61)	58(49,61)	<0.001
Laboratory characteristics
Creatinine (μmol/l)	78.0(71.0,87.0)	76.5(69.0,86.8)	70.0(62.0,82.0)	<0.001
TC (mmol/l)	4.6(4.0,5.3)	4.8(4.0,5.4)	4.7(3.9,5.5)	0.340
HDL-C (mmol/l)	0.9(0.8,1.1)	0.9(0.8,1.1)	0.9(0.8,1.0)	0.482
LDL-C (mmol/l)	3.2(2.6,3.8)	3.2(2.5,3.8)	3.1(2.4,3.8)	0.279
TG (mmol/l)	1.8(1.4,2.5)	2.1(1.4,3.1)	2.1(1.5,3.2)	<0.001
FBG (mmol/l)	4.9(4.6,5.3)	6.0(5.7,6.6)	8.2(6.7,11.2)	<0.001
HbA1c	5.3(5.1,5.5)	5.8(5.5,6.0)	7.8(6.9,9.5)	<0.001
Hs-CPR (mg/l)	2.6(1.0,7.3)	3.2(1.2,9.5)	3.6(1.3,8.7)	0.031
Grace Score	74(59,89)	74(59,88)	77(59,90)	0.336
Medications
Aspirin, n (%)	506(99.2)	300(99.7)	298(99.0)	0.611
Clopidogrel, n (%)	380(74.5)	218(72.4)	217(72.1)	0.697
Ticagrelor, n (%)	124(24.3)	82(27.2)	81(26.9)	0.574
ACEI/ARB, n (%)	266(52.2)	168(55.8)	176(58.5)	0.202
Statin, n (%)	484(94.9)	292(97.0)	290(96.3)	0.307
Beta-blocker, n (%)	377(73.9)	242(80.4)	254(84.4)	0.001
Mononitrate, n (%)	134(26.3)	72(23.9)	96(31.9)	0.074
Insulin, n (%)	-	-	93(30.9)	-
Metformin, n (%)	-	-	67(22.3)	-
Sulphonyurea, n (%)	-	-	43(14.3)	-
Non-sulfonylurea insulin, n (%)	-	-	18(6.0)	-
α-Glucosidase inhibitors, n (%)	-	-	123(40.9)	-

Note: Data are expressed as mean ± SD, median with 25th and 75th percentiles, or n (%).

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; LVEF, left ventricular ejection fraction; FBG, fasting blood glucose; HbA1c, Hemoglobin A1c; Hs-CRP, high-sensitivity C-reactive protein; TC, triglyceride TG, triglyceride; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; ACEIs, angiotensin-converting enzyme; ARBs, angiotensin receptor blocker.

Table 2 Clinical Presentation and Coronary Angiography Outcomes of Patients According to Glucose or HbA1c on Admission

Variables	NMG	Pre-DM	DM	P
	(n=511)	(n=301)	(n=301)
Clinical presentation				<0.001
STEMI	174(34.1)	147(48.8)	122(40.5)
NSTEMI	103(20.2)	38(12.6)	53(17.6)
Unstable angina	234(45.8)	116(38.5)	126(41.9)
Number of lesion vessels (%)
1 vessel, n (%)	209(41.0)	113(37.5)	97(32.2)	0.004
2 vessels, n (%)	162(31.7)	105(34.9)	87(28.9)	0.003
3 vessels, n (%)	136(26.6)	80(26.6)	117(38.9)	0.003
LM, n (%)	19(3.7)	16(5.3)	6(2.0)	0.096
Gensini Score	40(22,72)	40(24,74)	48(24,80)	0.063
Target vessels
LAD, n (%)	315(61.8)	151(50.2)	176(58.5)	0.005
LCX, n (%)	100(19.6)	83(27.6)	64(21.4)	0.028
RAC, n (%)	156(30.6)	120(39.9)	107(35.5)	0.024
LM, n (%)	5(1.0)	1(0.3)	2(0.7)	0.568
Number. of target vessels	1.11±0.35	1.17±0.43	1.16±0.39	0.058
PTCA, n (%)	25(4.9)	19(6.3)	15(5.0)	0.659
Number. of stents implanted	1(1,2)	1(1,2)	1(1,2)	0.042

Note: Data are expressed as mean ± SD, median with 25th and 75th percentiles, or n (%).

Abbreviations: PTCA, percutaneous transluminal coronary angioplasty; LM, left main; STEMI, ST-elevation myocardial infarction; NSTEMI, non-ST-elevation myocardial infarction; LAD, left anterior descending branch; LCX, left circumflex branch of the coronary artery; RAC, right coronary artery.

Table 3 Clinical Outcomes of Young Patients with ACS During the Follow-Up

	NMG	Pre-DM	DM	P
	(n=511)	(n=301)	(n=301)
MACE	120(23.5)	88(29.2)	104(34.6)	0.003
Death, MI and stroke	27(5.3)	24(8.0)	29(9.6)	0.056
All-cause death	3(0.6)	4(1.3)	8(2.7)	0.047
MI	19(3.7)	17(5.6)	16(5.3)	0.374
Stroke	8(1.6)	4(1.3)	8(2.7)	0.408
Re-revascularization	92(18.0)	62(20.6)	74(24.6)	0.080

Abbreviations: NMG, normal glucose metabolism; pre-DM, prediabetes; DM, diabetes mellitus; MACE, major adverse cardiovascular events; Death, MI and stroke, the composite of all-cause death, myocardial infraction and stroke; MI, myocardial infarction.

Table 4 Univariate and Multivariate Cox Regression Analysis of Events According to Glucose or HbA1c on Admission

COX	Univariate		Multivariate
	HR (95% CI)	P	HR (95% CI)	P
MACE
NMG	1(Reference)	…	1(Reference)	…
Pre-DM	1.38(1.05–1.83)	0.023	1.38(1.03–1.84)	0.030
DM	1.65(1.27–2.16)	<0.001	1.71(1.29–2.26)	<0.001
Death, MI and stroke
NMG	1(Reference)	…	1(Reference)	…
Pre-DM	1.69(0.97–2.96)	0.064	1.92(1.05–3.49)	0.034
DM	1.93(1.14–3.28)	0.015	2.22(1.25–3.95)	0.007
MACE
Pre-DM	1(Reference)	…	1(Reference)	…
NMG	0.72(0.55–0.96)	0.024	0.73(0.54–0.97)	0.030
DM	1.20(0.90–1.60)	0.225	1.24(0.92–1.67)	0.162
Death, MI and stroke
Pre-DM	1(Reference)	…	1(Reference)	…
NMG	0.59(0.34–1.03)	0.065	0.52(0.29–0.95)	0.034
DM	1.14(0.66–1.98)	0.641	1.16(0.65–2.09)	0.620

Notes: Multivariate analysis: age, hypertension, dyslipidemia, Gensini score, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, and creatinine levels.

Abbreviations: HR, hazard ratio; CI, confidence interval; NMG, normal metabolic glucose; pre-DM, prediabetes; DM, diabetes mellitus; MACE, major adverse cardiovascular events. Death, MI and stroke, the composite of all-cause death, myocardial infraction and stroke.

Figure 2 Kaplan-Meier survival curve for MACE (A), Death, MI and Stroke (B), All-cause death (C), Myocardial infraction (D), Repeat revascularization (E) and Stroke (F).

Abbreviations: NMG, normal metabolism glucose; pre-DM, prediabetes; DM, diabetes mellitus. MACE, major adverse cardiovascular events; Death, MI and stroke, the composite of all-cause death, myocardial infraction and stroke.