Background
Methods
Study population
Blood sampling
CGMS protocol
75-g oral glucose tolerance test protocol
Long-term follow-up and definitions of major adverse cardiovascular and cerebrovascular events (MACCE)
Statistical analysis
Results
Baseline characteristics
Variables | All patients | Low MAGE | High MAGE | p-value |
---|---|---|---|---|
(n = 417) | (n = 268) | (n = 149) | ||
Age, years | 66 (56–74) | 66 (56–74) | 68 (58–75) | 0.275 |
Male, n (%) | 348 (83) | 219 (82) | 129 (85) | 0.201 |
Body mass index, kg/m2 | 26.8 (22.1–29.5) | 24.5 (22.4–27.3) | 23.9 (21.8–26.1) | 0.010 |
STE-ACS, n (%) | 292 (70) | 191 (71) | 101 (68) | 0.457 |
Killip class > 1, n (%) | 74 (18) | 40 (15) | 34 (23) | 0.042 |
Infarct-related artery, n (%) | ||||
Left anterior descending coronary artery, n (%) | 229 (55) | 150 (56) | 79 (53) | 0.562 |
Left circumflex coronary artery, n (%) | 45 (11) | 29 (11) | 16 (11) | 0.979 |
Right coronary artery, n (%) | 143 (34) | 89 (33) | 54 (36) | 0.532 |
Multivessel disease, n (%) | 176 (42) | 99 (37) | 77 (52) | 0.004 |
GRACE score > 140, n (%) | 212 (51) | 125 (47) | 87 (58) | 0.022 |
Hypertension, n (%) | 255 (61) | 155 (58) | 100 (67) | 0.063 |
Hypercholesteremia, n (%) | 160 (38) | 109 (41) | 51 (34) | 0.195 |
Systolic blood pressure on admission, mmHg | 150 (125–170) | 149 (125–167) | 153 (124–177) | 0.806 |
Heart rate on admission, bpm | 76 (64–88) | 76 (64–88) | 76 (65–90) | 0.575 |
Laboratory data | ||||
Cre on admission, mg/dl | 0.84 (0.72–1.00) | 0.84 (0.73–0.98) | 0.83 (0.71–1.02) | 0.720 |
eGFR on admission, % | 67.9 (56.3–81.1) | 67.3 (55.9–80.0) | 70.4 (56.3–83.1) | 0.091 |
Peak level of CPK, IU/l | 1129 (250–2864) | 1130 (243–2870) | 1129 (265–2838) | 0.696 |
BNP during stable phase, pg/ml | 89.2 (35.5–192.7) | 80.4 (35.4–171.4) | 101.3 (37.7–209.1) | 0.007 |
hs-CRP during stable phase > 0.1355 mg/dl, n (%) | 185 (44) | 115 (43) | 70 (47) | 0.393 |
Lipid profile on admission | ||||
LDL cholesterol, mg/dl | 128 (105–152) | 131 (108–155) | 124 (102–148) | 0.114 |
HDL cholesterol, mg/dl | 44 (37–52) | 43 (37–51) | 45 (37–52.5) | 0.131 |
Triglycerides, mg/dl | 118 (75–185) | 124 (78–197) | 113 (70–162) | 0.125 |
Medication on discharge, n (%) | ||||
ACE-I or ARB | 334 (80) | 210 (78) | 124 (83) | 0.233 |
β-blocker | 275 (66) | 175 (65) | 100 (67) | 0.708 |
Statin | 400 (96) | 258 (96) | 142 (95) | 0.632 |
Variables | All patients | Low MAGE | High MAGE | p-Value |
---|---|---|---|---|
(n = 417) | (n = 268) | (n = 149) | ||
75 g OGTT findings | ||||
Diabetes mellitus, n (%) | 140 (34) | 55 (21) | 85 (57) | < 0.001 |
Impaired glucose tolerance, n (%) | 185 (44) | 135 (50) | 50 (34) | < 0.001 |
Normal glucose tolerance, n (%) | 92 (22) | 78 (29) | 14 (9) | < 0.001 |
Glucose on admission, mg/dl | 142 (118–182) | 133 (114–165) | 163 (130–217) | < 0.001 |
Glucose on admission > 180 mg/dl | 105 (25) | 49 (18) | 56 (38) | < 0.001 |
Hemoglobin A1c level, % | 5.9 (5.5–6.4) | 5.8 (5.5–6.1) | 6.3 (5.7–7.3) | < 0.001 |
CGM findings | ||||
MAGE, mg/dl | 40.6 (27.59.5) | 31.8 (24.39.7) | 65.0 (57.8–79) | < 0.001 |
Ave, mg/dl | 120 (108–136) | 115 (106–126) | 134 (120–170) | < 0.001 |
SD | 17.0 (12.1–25.1) | 13.5 (10.5–17.2) | 28 (22.4–35.9) | < 0.001 |
CV | 14.0 (10.2–18.7) | 11.3 (9.1–14.2) | 19.7 (16.4–23.6) | < 0.001 |
Incidence of MACCE
Prediction of MACCE
Variables | OR | 95% CI | p-value |
---|---|---|---|
Age, per 1 year | 1.007 | 0.985–1.031 | 0.511 |
Male | 0.990 | 0.489–2.005 | 0.978 |
Body mass index, per 1 kg/m2 | 0.943 | 0.872–1.015 | 1.060 |
STE-ACS | 0.831 | 0.474–1.456 | 0.559 |
Killip class > 1 | 1.028 | 0.520–2.037 | 0.935 |
Culprit LAD | 0.982 | 0.579–1.666 | 0.947 |
Culprit LCx | 0.488 | 0.169–1.411 | 0.177 |
Cilprit RCA | 1.300 | 0.757–2.234 | 0.341 |
Multivessel disease | 0.411 | 0.240–0.704 | 0.001 |
GRACE score > 140 | 1.283 | 0.756–2.178 | 0.355 |
Hypertension | 0.838 | 0.492–1.429 | 0.516 |
Hypercholesterolemia | 1.053 | 0.614–1.804 | 0.852 |
Systolic blood pressure on admission, per 1 mmHg | 0.995 | 0.988–1.002 | 0.214 |
Heart rate on admission, per 1 bpm | 1.003 | 0.990–1.017 | 0.638 |
Cre on admission, per 1 mg/dl | 1.598 | 0.909–2.914 | 0.098 |
eGFR on admission, per 1% | 0.996 | 0.982–1.008 | 0.522 |
Peak level of CPK, per 1 IU/l | 1.000 | 0.999–1.000 | 0.534 |
BNP during stable phase, per 1 pg/ml | 1.001 | 1.000–1.003 | 0.013 |
hs-CRP during stable phase > 0.1355 mg/dl | 2.278 | 1.325–3.915 | 0.002 |
LDL cholesterol, per 1 mg/dl | 1.000 | 0.993–1.007 | 0.994 |
HDL cholesterol, per 1 mg/dl | 0.972 | 0.946–0.996 | 0.030 |
Triglycerides, per 1 mg/dl | 0.999 | 0.997–1.001 | 0.571 |
ACE-I or ARB use at discharge | 0.737 | 0.396–1.374 | 0.336 |
β-blocker use at discharge | 1.127 | 0.642–1.979 | 0.676 |
Statin use at discharge | 0.596 | 0.188–1.888 | 0.374 |
Diabetes mellitus | 1.251 | 0.726–2.158 | 0.420 |
Impaired glucose tolerance | 1.218 | 0.719–2.063 | 0.463 |
Normal glucose tolerance | 0.510 | 0.242–1.074 | 0.072 |
Glucose on admission > 180 mg/dl | 2.238 | 1.286–3.893 | 0.004 |
Hemoglobin A1c level, % | 1.267 | 1.030–1.546 | 0.021 |
High MAGE | 2.347 | 1.378–3.998 | 0.001 |
Ave, mg/dl | 1.001 | 0.998–1.013 | 0.155 |
SD | 1.016 | 0.994–1.038 | 0.141 |
CV | 1.020 | 0.982–1.058 | 0.293 |
Variables | Multivariate (Model 1) | Multivariate (Model 2) | Multivariate (Model 3) | ||||||
---|---|---|---|---|---|---|---|---|---|
OR | 95% CI | p-value | OR | 95% CI | p-value | OR | 95% CI | p-value | |
Multivessel disease | 2.251 | 1.294–3.968 | 0.004 | – | 2.075 | 1.176–3.703 | 0.012 | ||
BNP during stable phase, per 1 pg/ml | 1.001 | 0.999–1.003 | 0.104 | – | 1.001 | 0.999–1.002 | 0.232 | ||
hs-CRP during stable phase > 0.1355 mg/dl | 2.026 | 1.166–3.575 | 0.012 | – | 2.103 | 1.196–3.761 | 0.010 | ||
HDLC, per 1 mg/dl | 0.974 | 0.012–0.944 | 0.052 | – | 0.976 | 0.948–1.002 | 0.077 | ||
Glucose on admission > 180 mg/dl | – | 1.798 | 0.920–3.439 | 0.085 | 1.723 | 0.869–3.349 | 0.118 | ||
HbA1c, per 1% | – | 1.045 | 0.807–1.334 | 0.728 | 1.050 | 0.800–1.361 | 0.714 | ||
High MAGE | – | 2.030 | 1.159–3.563 | 0.014 | 1.844 | 1.013–3.356 | 0.045 |
Variables | AUC | 95% CI | Increment of AUC vs Model 1 | 95% CI | p-value |
---|---|---|---|---|---|
Model 1 | 0.68 | 0.629–0.722 | – | – | – |
Model 2 | 0.63 | 0.582–0.678 | 0.05 | − 0.052–0.144 | 0.358 |
Model 3 | 0.72 | 0.676–0.765 | 0.05 | − 0.000–0.091 | 0.055 |
Variables | Multivariate (Model 1) | Multivariate (Model 2) | Multivariate (Model 3) | ||||||
---|---|---|---|---|---|---|---|---|---|
OR | 95% CI | p-value | OR | 95% CI | p-value | OR | 95% CI | p-value | |
Patients with DM | |||||||||
Hypertension | 0.435 | 0.157–1.145 | 0.092 | – | 0.438 | 0.105–6.510 | 0.105 | ||
Cre on admission, per 1 mg/dl | 1.141 | 0.407–4.202 | 0.829 | – | 1.208 | 0.401–4.762 | 0.768 | ||
BNP during stable phase, per 1 pg/ml | 1.002 | 0.999–1.005 | 0.053 | – | 1.002 | 0.999–1.005 | 0.072 | ||
HDLC, per 1 mg/dl | 0.962 | 0.909–1.011 | 0.134 | – | 0.966 | 0.912–1.017 | 1.035 | ||
Glucose on admission > 180 mg/dl | – | 2.415 | 0.861–7.232 | 0.094 | 2.038 | 0.660–6.666 | 0.217 | ||
HbA1c, per 1% | – | 1.154 | 0.842–1.575 | 0.364 | 1.091 | 0.753–1.562 | 0.637 | ||
High MAGE | – | 2.780 | 1.017–8.956 | 0.046 | 3.238 | 1.041–12.38 | 0.042 | ||
Patients with IGT | |||||||||
Multivessel disease | 4.586 | 2.028–10.843 | < 0.001 | – | 4.036 | 1.747–9.694 | 0.001 | ||
hs-CRP during stable phase > 0.1355 mg/dl | 3.766 | 1.641–9.226 | 0.002 | – | 3.857 | 1.664–9.576 | 0.001 | ||
High MAGE | – | 2.528 | 1.145–5.581 | 0.024 | 2.080 | 0.861–4.957 | 0.102 |