Prediabetes and long-term outcomes in patients with three-vessel coronary artery disease: A large single-center cohort study

Abstract

Aims/introduction: Whether detection of prediabetes by routinely testing hemoglobin A_1c and fasting plasma glucose in three-vessel disease patients could identify individuals at high risk of future cardiovascular disease events remains unclear. This study evaluated the relationship between different glycemic status and clinical outcomes in this specific population.

Materials and methods: This study included 8,891 Chinese patients with three-vessel disease. Patients were categorized according to their glycemic status (normoglycemia [NG], n = 3,195; prediabetes, n = 1,978; diabetes mellitus, n = 3,718).

Results: The median follow-up time was 7.5 years, during which 1,354 deaths and 2,340 major adverse cardiac and cerebrovascular events occurred. Compared with the NG group, patients in the prediabetes and diabetes mellitus groups had more comorbidities. After adjusting for confounders, the diabetes mellitus group had a higher risk of all-cause death (hazard ratio [HR] 1.36, 95% confidence interval [CI] 1.20-1.53; P < 0.001), cardiac death (HR 1.35, 95% CI 1.14-1.61; P = 0.001) and major adverse cardiac and cerebrovascular events (HR 1.22, 95% CI 1.11-1.34; P < 0.001) compared with the NG group, whereas the prediabetes and NG groups had no significant difference. The diabetes mellitus group also had a higher risk of stroke compared with the NG group (HR 1.22, 95% CI 1.02-1.46; P = 0.031).

Conclusions: In the context of three-vessel disease, prediabetes patients have comparable long-term outcomes in terms of major adverse cardiac and cerebrovascular events, cardiac death and all-cause death to those with NG. Routine screening of glycemic metabolism based on hemoglobin A_1c and fasting plasma glucose might be valuable to identify individuals with diabetes mellitus who are at high risk of future cardiovascular disease events and individuals with prediabetes who are at high risk of progressing to diabetes mellitus.

Keywords: Diabetes; Prediabetes; Three-vessel disease.