Diagnostic and prognostic value of glycemic variability in patients with obstructive coronary artery disease after percutaneous coronary intervention

Abstract

The aim – assessment of the diagnostic and prognostic value of glycemic variability indicators in patients with coronary artery disease (CAD) after percutaneous coronary intervention followed by optimal drug therapy.Materials and methods. 121 patients with impaired glucose metabolism took part in the study, who, depending on the presence of CAD, were divided into two groups: group I (n=65) – CAD (+), group II (n=56) – CAD (-). Glucose variability was determined using a continuous glucose monitoring system for 6 days before the start of the study. The method of choice for coronary artery revascularization was percutaneous coronary intervention followed by optimal drug therapy. The results of the study were evaluated by the presence of clinical manifestations of the progression of coronary heart disease and the development of acute cardiovascular events in patients.Results and discussion. Distribution of patients by gender, bad habits and most concomitant diseases, both groups were comparable, the average age of patients was 54.2 years. With comparable initial values ​​of glycated hemoglobin (7.3±0.9 % vs 7.5±1.2 %, p=0.29), the indicators of glycemia variability were significantly higher in patients with coronary artery disease (mean glucose 8.6±2.1 vs 7.5±1.9 mmol/L; p<0.05). During the observation period (2 years), 20 patients (16.5 %), of which 17 (14.1 %) had a history of CHD and 3 (2.5 %) without a previous diagnosis of CHD, had clinical signs of progression of this disease. 7 (5.8 %) patients developed an acute coronary syndrome, among which 3 (2.5 %) had unstable angina, 3 (2.5 %) had an acute non-Q myocardial infarction, and 1 (0.8 %) had an acute Q-myocardial infarction. When comparing the frequency of development and assessing the relative risk of progression of clinical symptoms of CAD and the development of acute cardiovascular events, the most significant factors were the percentage of time below the target range of glycemia < 3.9 mmol/l more than 5 % per day and SD above 2.Conclusion. Increased glycemic variability (SD > 2 mmol/L) and period of hypoglycemia < 3.9 mmol/L more than 3 % per day are negatively associated with clinical progression of CAD and the development of recurrent acute cardiovascular events in middle-aged patients with concomitant diabetes mellitus after percutaneous coronary intervention followed by optimal drug therapy.