Prognostic value of glucose metabolism for non-ST-segment elevation infarction patients with diabetes mellitus and single concomitant chronic total occlusion following primary percutaneous coronary intervention
| Autor: | Lei Zhang, Zhiqiang Liu, Yu-Chun Yang, Zhi Xing, Muhuyati Wulasihan, Peng-Yi He |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Shock Cardiogenic Infarction Observational Study Hemorrhage Kaplan-Meier Estimate 030204 cardiovascular system & hematology Revascularization 03 medical and health sciences 0302 clinical medicine Percutaneous Coronary Intervention Internal medicine Diabetes mellitus medicine Myocardial Revascularization Humans Homeostatic Model Assessment 2 for Insulin Resistance 030212 general & internal medicine Non-ST Elevated Myocardial Infarction chronic total occlusion Aged glycosylated hemoglobin Glycated Hemoglobin Ejection fraction business.industry Cardiogenic shock Hazard ratio Percutaneous coronary intervention Stroke Volume General Medicine Middle Aged medicine.disease Prognosis primary percutaneous coronary intervention Stroke NSTEMI Glucose Coronary Occlusion Diabetes Mellitus Type 2 Conventional PCI diabetes mellitus Cardiology Female Insulin Resistance business Research Article |
| Zdroj: | Medicine |
| ISSN: | 1536-5964 |
| Popis: | Glucose metabolism status may play a predictive role in the severity of the complications among patients with type 2 diabetes mellitus (DM). However, few studies have focused on the prognostic value of glycosylated hemoglobin (HbA1c) and Homeostatic Model Assessment 2 for Insulin Resistance (HOMA2-IR) in patients with DM, non-ST-segment elevation infarction (NSTEMI), and single concomitant chronic total occlusion (CTO) following primary percutaneous coronary intervention (PCI). Short- and long-term prognostic value of HbA1c and HOMA2-IR in patients with DM with NSTEMI and single CTO who received primary percutaneous transluminal coronary intervention (pPCI). Data from 202 patients with NSTEMI and single CTO in nonculprit vessels were included. The incidence of revascularization, cardiogenic shock, ischemic stroke, major bleeding (ie, cerebral hemorrhage or massive hemorrhage of gastrointestinal tract), and cardiac death were combined as composite end points (CEPs). HbA1c was measured on admission and at 12 and 24 weeks after discharge. HOMA2-IR was measured on admission and at 6 and 12 weeks after discharge. The mean value of HbA1c and HOMA2-IR was calculated to determine the impact on 2.5-year CEPs. All patients were assessed during hospitalization and followed for up to 2.5 years after discharge. Mean age was 62.4 ± 11.8 years and 76% were male. Previous MI, lower left ventricular ejection fraction, and higher HbA1c (hazard ratio [HR] = 1.216; 95% confidence interval [CI] = 1.023–1.445; P = .023) were independently associated with a poor prognosis at 2.5 years. Higher HbA1c and HOMA2-IR on admission was associated with CEPs during hospitalization. Mean HOMA2-IR prior to pPCI was associated with revascularization (HR = 1.129; 95% CI = 1.008–1.265; P = .036) and ischemic stroke (HR = 1.276; 95% CI = 1.044–1.560; P = .017) during the 2.5 years follow-up period. Glucose metabolism status reflected by HbA1c and HOMA2-IR may provide prognostic value to patients with NSTEMI, type 2 DM, and single concomitant CTO following PCI. Therefore, patients with NSTEMI, CTO, and poor glycemic control should be carefully evaluated prior to PCI. |
| Databáze: | OpenAIRE |
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