Intermediate Hyperglycemia Increases the Risk of All-Cause Mortality in Premature Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention

Ziyou Zhou^1,2,3,†, Linfang Qiao^2,3,4,†, Yihang Ling^2,3,4,†, Yibo He^2,3,†, Tian Chang^1,2,3,†, Hongyu Lu^2,3, Sijia Yu⁴, Jin Liu^2,3, Wei Guo⁵, Shiqun Chen^6,*, Yong Liu^1,2,3,*, Jiyan Chen^1,2,3,*

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¹ School of Medicine, South China University of Technology, 510006 Guangzhou, Guangdong, China

² Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 510080 Guangzhou, Guangdong, China

³ Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, Guangdong, China

⁴ The Second School of Clinical Medicine, Southern Medical University, 510515 Guangzhou, Guangdong, China

⁵ Guangdong Provincial Geriatrics Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, Guangdong, China

⁶ Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, 510100 Guangzhou, Guangdong, China

^*Correspondence: shiqunchen@126.com (Shiqun Chen); liuyong@gdph.org.cn (Yong Liu); chenjiyandr@126.com (Jiyan Chen)
^†These authors contributed equally.

Rev. Cardiovasc. Med. 2023, 24(12), 352; https://doi.org/10.31083/j.rcm2412352

Submitted: 14 June 2023 | Revised: 7 August 2023 | Accepted: 11 August 2023 | Published: 13 December 2023

(This article belongs to the Special Issue Advances in Coronary and Structural Heart Interventions)

This is an open access article under the CC BY 4.0 license.

Abstract

Background: Hyperglycemia has been associated with an adverse prognosis in patients with premature coronary artery disease (CAD). However, whether the intermediate hyperglycemia status affects the risk of mortality in premature CAD patients treated with percutaneous coronary intervention (PCI), remains unclear. Methods: We retrospectively included 14,585 premature CAD patients undergoing PCI from 2007 to 2020. Patients were divided into normal glycemia ( $<$ 6%), intermediate hyperglycemia (6%–6.5%), and hyperglycemia ( $\geq$ 6.5%) according to hemoglobin A1c (HbA1c) level in whole blood. Follow-up all-cause mortality was defined as a primary outcome, and Cox proportional regression analysis was used to assess the association between glycemia status and the primary outcome. Results: Among 14,585 premature CAD patients undergoing PCI (mean age 43.6 $\pm{}$ 7.6 years, 28.1% female), 2856 (19.6%) were diagnosed with intermediate hyperglycemia. Over a median follow-up of 4.62 years (2.72–7.19 years), patients with hyperglycemia were correlated with higher risk (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.19–1.54, p $<$ 0.001) while patients with intermediate hyperglycemia were associated with intermediate mortality risk from all causes (HR 1.17, 95% CI 1.0–1.36, p = 0.049). Conclusions: Intermediate hyperglycemia was positively associated with all-cause mortality risk in patients with premature CAD undergoing PCI. Active glucose-lowering therapy may be considered in these patients. Clinical Trial Registration: NCT05050877.

Keywords

premature coronary artery disease

intermediate hyperglycemia

mortality

percutaneous coronary intervention

Funding

2020B1111170011/Guangdong Provincial science and technology project

KJ022021049/Guangdong Provincial science and technology project

82070360/National Science Foundation for Young Scientists of China

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