Abstract 19373: Glycemic Variability Determined by Continuous Glucose Monitoring System Predicts Rapid Progression of Non-culprit Lesions in Patients With Acute Coronary Syndromes

Abstract

Backgounds: Rapid progression (RP) of coronary artery disease (CAD) has been shown to be a powerful predictor of cardiovascular events. However, the predictor of RP in patients with acute coronary syndromes (ACS) remains to be fully elucidated. Methods We prospectively investigated the clinical impact of glycemic variability (GV) as determined by a continuous glucose monitoring system (CGMS) on RP of non-culprit lesions in 107 patients with ACS. All patients underwent emergent and follow up angiography 11 months after the initial angiography repeatedly. Patients with type 1 DM, an inflammatory disease, or CKD stage G4 and G5 were excluded. RP was defined as a ≥10% diameter reduction in a preexisting stenosis of ≥50%, a ≥30% diameter reduction in a stenosis of <50%, development of a new stenosis of ≥30% in a previously normal segment, or progression of any stenosis to total occlusion. Patients were classified into 2 groups according to the presence (progressor, n = 21) or absence (non-progressor, n = 86) of RP. 4 cases out 110 patients had ACS during their follow up (Figure).All patients were equipped with a CGMS during the stable phase, and mean amplitude of glycemic excursion (MAGE) levels were calculated as a marker of GV. Results: The mean value of MAGE was significantly higher in progressor than in non-progressor (52 ± 19 mg/dL vs. 40 ± 21 mg/dL, P = 0.02). (Table) Multiple logistic regression analysis showed that the value of MAGE was an independent predictor of RP (odds ratio, 1.06 per 1 mg/dL; P <0.01). Conclusions: In prediction of RP, the value of MAGE was superior to that of HbA1c. The value of MAGE early after the onset of ACS is a predictor of RP of non-culprit lesions.