title: Comparison of frequency of periprocedural myocardial infarction in patients with and without diabetes mellitus to those with previously unknown but elevated glycated hemoglobin levels (from the TWENTE Trial).
abstract: In patients without a history of diabetes mellitus, increased levels of glycated hemoglobin (HbA1c) are associated with higher cardiovascular risk. The relation between undetected diabetes and clinical outcome after percutaneous coronary intervention is unknown. To investigate whether these patients may have an increased risk of periprocedural myocardial infarction (PMI), the most frequent adverse event after percutaneous coronary intervention, we assessed patients of the TWENTE trial (a randomized, controlled, second-generation drug-eluting stent trial) in whom HbA1c data were available. Patients were classified as known diabetics or patients without a history of diabetes who were subdivided into undetected diabetics (HbA1c ≥6.5%) and nondiabetics (HbA1c <6.5%). Systematic measurement of cardiac biomarkers and electrocardiographic assessment were performed. One-year clinical outcome was also compared. Of 626 patients, 44 (7%) were undetected diabetics, 181 (29%) were known diabetics, and 401 (64%) were nondiabetics. In undetected diabetics the PMI rate was higher than in nondiabetics (13.6% vs 3.7%, p = 0.01) and known diabetics (13.6% vs 6.1%, p = 0.11). Multivariate analysis adjusting for covariates confirmed a significantly higher PMI risk in undetected diabetics compared to nondiabetics (odds ratio 6.13, 95% confidence interval 2.07 to 18.13, p = 0.001) and known diabetics (odds ratio 3.73, 95% confidence interval 1.17 to 11.89, p = 0.03). After 1 year, target vessel MI rate was significantly higher in undetected diabetics (p = 0.02) than in nondiabetics, which was related mainly to differences in PMI. Target vessel failure was numerically larger in unknown diabetics than in nondiabetics, but this difference did not reach statistical significance (13.6% vs 8.0%, p = 0.25). In conclusion, undetected diabetics were shown to have an increased risk of PMI.
authors.affiliation: Department of Cardiology, Thoraxcentrum, Twente, the Netherlands, and Medisch Spectrum Twente, Enschede, the Netherlands.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Tandjung
authors.forename: K Gert
authors.initials: KG
authors.lastname: van Houwelingen
authors.forename: Hanneke
authors.initials: H
authors.lastname: Jansen
authors.forename: Mounir W Z
authors.initials: MW
authors.lastname: Basalus
authors.forename: Hanim
authors.initials: H
authors.lastname: Sen
authors.forename: Marije M
authors.initials: MM
authors.lastname: Löwik
authors.forename: Martin G
authors.initials: MG
authors.lastname: Stoel
authors.forename: J Hans W
authors.initials: JH
authors.lastname: Louwerenburg
authors.forename: Frits H A F
authors.initials: FH
authors.lastname: de Man
authors.forename: Gerard C M
authors.initials: GC
authors.lastname: Linssen
authors.forename: Rogier
authors.initials: R
authors.lastname: Nijhuis
authors.forename: Mark B
authors.initials: MB
authors.lastname: Nienhuis
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Stolk
authors.forename: Clemens
authors.initials: C
authors.lastname: von Birgelen
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000097:blood*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D009426:Netherlands / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D012307:Risk Factors; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin