Glycemic Variability Is a Powerful Independent Predictive Factor of Midterm Major Adverse Cardiac Events in Patients With Diabetes With Acute Coronary Syndrome

Author:

Gerbaud Edouard12,Darier Romain1,Montaudon Michel2,Beauvieux Marie-Christine3,Coffin-Boutreux Christine4,Coste Pierre12,Douard Hervé5,Ouattara Alexandre67,Catargi Bogdan8ORCID

Affiliation:

1. Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France

2. Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Bordeaux, France

3. Biochemistry Laboratory, Hôpital Cardiologique du Haut Lévêque, Bordeaux University, Pessac, France

4. Endocrinology-Nutrition Department, Centre Hospitalier de Périgueux, Périgueux, France

5. Department of Cardiovascular Medicine, Hôpital Cardiologique du Haut Lévêque, Bordeaux University, Pessac, France

6. Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux University, Pessac, France

7. Biology of Cardiovascular Diseases Centre, U1034, Bordeaux University, Pessac, France

8. Endocrinology-Metabolic Diseases, Hôpital Saint-André, Bordeaux University, Bordeaux, France

Abstract

OBJECTIVE Acute glucose fluctuations are associated with hypoglycemia and are emerging risk factors for cardiovascular outcomes. However, the relationship between glycemic variability (GV) and the occurrence of midterm major cardiovascular events (MACE) in patients with diabetes remains unclear. This study investigated the prognostic value of GV in patients with diabetes and acute coronary syndrome (ACS). RESEARCH DESIGN AND METHODS This study included consecutive patients with diabetes and ACS between January 2015 and November 2016. GV was assessed using SD during initial hospitalization. MACE, including new-onset myocardial infarction, acute heart failure, and cardiac death, were recorded. The predictive effects of GV on patient outcomes were analyzed with respect to baseline characteristics and cardiac status. RESULTS A total of 327 patients with diabetes and ACS were enrolled. MACE occurred in 89 patients (27.2%) during a mean follow-up of 16.9 months. During follow-up, 24 patients (7.3%) died of cardiac causes, 35 (10.7%) had new-onset myocardial infarction, and 30 (9.2%) were hospitalized for acute heart failure. Multivariable logistic regression analysis showed that GV >2.70 mmol/L, a Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score >34, and reduced left ventricular ejection fraction of <40% were independent predictors of MACE, with odds ratios (ORs) of 2.21 (95% CI 1.64–2.98; P < 0.001), 1.88 (1.26–2.82; P = 0.002), and 1.71 (1.14–2.54; P = 0.009), respectively, whereas a Global Registry of Acute Coronary Events (GRACE) risk score >140 was not (OR 1.07 [0.77–1.49]; P = 0.69). CONCLUSIONS A GV cutoff value of >2.70 mmol/L was the strongest independent predictive factor for midterm MACE in patients with diabetes and ACS.

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

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