title: Periprocedural glycemic control in patients with diabetes mellitus undergoing coronary angiography with possible percutaneous coronary intervention.
abstract: Periprocedural hyperglycemia is an independent predictor of mortality in patients who underwent percutaneous coronary intervention (PCI). However, periprocedural management of blood glucose is not standardized. The effects of routinely continuing long-acting glucose-lowering medications before coronary angiography with possible PCI on periprocedural glycemic control have not been investigated. Patients with diabetes mellitus (DM; n = 172) were randomized to continue (Continue group; n = 86) or hold (Hold group; n = 86) their clinically prescribed long-acting glucose-lowering medications before the procedure. The primary end point was glucose level on procedural access. In a subset of patients (no DM group: n = 25; Continue group: n = 25; and Hold group: n = 25), selected measures of platelet activity that change acutely were assessed. Patients with DM randomized to the Continue group had lower blood glucose levels on procedural access compared with those randomized to the Hold group (117 [97 to 151] vs 134 [117 to 172] mg/dl, p = 0.002). There were two hypoglycemic events in the Continue group and none in the Hold group, and no adverse events in either group. Selected markers of platelet activity differed across the no DM, Continue, and Hold groups (leukocyte platelet aggregates: 8.1% [7.2 to 10.4], 8.7% [6.9 to 11.4], 10.9% [8.6 to 14.7], p = 0.007; monocyte platelet aggregates: 14.0% [10.3 to 16.3], 20.8% [16.2 to 27.0], 22.5% [15.2 to 35.4], p <0.001; soluble p-selectin: 51.9 ng/ml [39.7 to 74.0], 59.1 ng/ml [46.8 to 73.2], 72.2 ng/ml [58.4 to 77.4], p = 0.014). In conclusion, routinely continuing clinically prescribed long-acting glucose-lowering medications before coronary angiography with possible PCI help achieve periprocedural euglycemia, appear safe, and should be considered as a strategy for achieving periprocedural glycemic control.
authors.affiliation: Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York. Electronic address: binita.shah@nyumc.org.
authors.forename: Binita
authors.initials: B
authors.lastname: Shah
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York; Division of Hematology, Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Berger
authors.affiliation: Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Amoroso
authors.affiliation: Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York.
authors.forename: Xingchen
authors.initials: X
authors.lastname: Mai
authors.affiliation: Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Lorin
authors.affiliation: Division of Endocrinology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York.
authors.forename: Ann
authors.initials: A
authors.lastname: Danoff
authors.affiliation: Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York.
authors.forename: Arthur Z
authors.initials: AZ
authors.lastname: Schwartzbard
authors.affiliation: Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York.
authors.forename: Iryna
authors.initials: I
authors.lastname: Lobach
authors.affiliation: Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York.
authors.forename: Yu
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York.
authors.forename: Frederick
authors.initials: F
authors.lastname: Feit
authors.affiliation: Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York.
authors.forename: James
authors.initials: J
authors.lastname: Slater
authors.affiliation: Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Attubato
authors.affiliation: Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Sedlis
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D001792:Blood Platelets / Q000502:physiology; D017023:Coronary Angiography; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D057234:Preoperative Period
chemical_list: D001786:Blood Glucose