Interactions between Hyperglycemia and Prior Ischemic Events in Patients Undergoing Percutaneous Coronary Revascularization: Contrasting Evidence from Bench and Bedside?

Fabrizio D’Ascenzo,Giada Longo,Claudio Moretti

doi:10.4172/2161-1025.1000102

Abstract

Objectives and Background: Many clinical studies have established an increased risk of death and myocardial infarction in patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI), experimental evidence is increasingly suggesting a greater resistance of diabetic animals to ischemic injury. Whether this holds true also in humans is debated. Methods: Consecutive patients undergoing PCI in our centre between July 2002 and June 2004 were divided into 4 groups: patients with DM and a history of myocardial ischemia (i.e. prior myocardial infarction [MI] or prior coronary revascularization) were included in the diabetes and ischemia (DI) group, those with DM but without prior ischemia in the diabetes only (DO) group, those with previous ischemia but non diabetic in ischemic only group (IO) and non- diabetics without ischemia in the ND group. The primary outcomes were 30-day and at least three years rates of death, myocardial infarction, or repeat revascularization. Results: A total of 152 patients were included in the DI group, 173 in the DO group, 449 in the IO group and 836 in the ND group. Overall, patients belonging to DI groups had higher rates of risk factors, but did not report higher incidence of adverse outcomes, both at short and at long term follow-up. Conclusions: Clinical evidence suggests a neutral interaction between diabetes and previous ischemic injury, thus paving the way to establish if the presence of previous cardiovascular events influences the cogency of different glycemia target level protocols.

Highlights

Diabetes mellitus (DM) is considered a risk factor for coronary artery disease but a coronary artery disease equivalent [1]
They were divided into 4 groups: patients with DM and a history of myocardial ischemia, that is a prior myocardial infarction (MI) or a prior percutaneous or surgical revascularization, were included in the diabetes and ischemia (DI) group, those with a diagnosis of DM without ischemia in the diabetes only (DO) group, those with previous ischemia but non diabetic in ischemic only group (IO) and non-diabetics without an history of ischemia in the ND group
During coronary angiography small vessel disease was more frequently found in diabetic people (35.2% vs 22.9%, p

Summary

Introduction

Diabetes mellitus (DM) is considered a risk factor for coronary artery disease but a coronary artery disease equivalent [1]. Patients with diabetes mellitus tend to have worse outcomes after percutaneous coronary intervention (PCI) than non diabetic patients [2,3,4,5,6,7], proving negative clinical relation between exposition to high level of glucose and cardiac ischemia [813]. There is contrasting evidence about target level of glucose to pursue for patients undergoing PCI, without a clear benefit related to an aggressive glucose lowering strategy [14,15,16,17,18,38]. To our knowledge no observational studies performed on patients have investigated value and degree of interaction between diabetes mellitus and cardiac ischemia. In order to address this issue, we retrospectively analyzed an unselected population undergoing PCI in our center

Objectives

Methods

Results

Discussion

Conclusion