Background
Methods
Study protocol
Laboratory analysis
Inflammatory markers
Quantitative coronary angiography
Coronary care unit/intensive cardiac care unit
Echocardiographic assessment
Follow-up
Cardiovascular endpoints
Statistical analysis
Results
Non-diabetic patients | Diabetic patients | p | PSM-diabetic never incretin users | PSM-diabetic current incretin users | p | |
---|---|---|---|---|---|---|
N | 796 | 292 | 67 | 67 | ||
Mean age (years) | 65.5 ± 5.9 | 64.9 ± 9.5 | 0.184 | 64.4 ± 5.7 | 65.3 ± 5.7 | 0.289 |
Sex (M/F) | 446/350 | 157/135 | – | 37/30 | 39/28 | – |
BMI (kg/m2) | 27.5 ± 1.1 | 29.0 ± 1.9 | 0.001 | 29.3 ± 2.1 | 29.2 ± 2.8 | 0.732 |
Diabetes duration (years) | – | 16.6 ± 3.4 | – | 16.2 ± 3.1 | 16.8 ± 3.4 | 0.299 |
Systolic blood pressure (mmHg) | 126.9 ± 9.2 | 125.9 ± 10.4 | 0.129 | 124.5 ± 10.4 | 125.8 ± 11.3 | 0.507 |
Diastolic blood pressure (mmHg) | 79.7 ± 8.6 | 79.1 ± 6.7 | 0.294 | 79.8 ± 6.6 | 79.8 ± 6.6 | 0.727 |
Heart rate (bpm) | 85.1 ± 7.4 | 85.9 ± 9.1 | 0.148 | 86.3 ± 11.2 | 86.7 ± 8.5 | 0.789 |
Grace score, n (%) | ||||||
I | 532 (66.8) | 204 (69.9) | 0.192 | 42 (62.3) | 38 (56.8) | 0.192 |
II | 209 (26.3) | 76 (26.0) | 0.503 | 21 (31.3) | 24 (35.8) | 0.357 |
III | 45 (5.7) | 14 (4.8) | 0.350 | 4 (5.9) | 5 (7.5) | 0.341 |
Risk factors | ||||||
Stress hyperglycemia, n (%) | 39 (4.9) | 91 (31.2) | 0.001 | 30 (44.8) | 27 (40.3) | 0.363 |
Hypertension, n (%) | 427 (53.6) | 230 (78.8) | 0.001 | 55 (82.1) | 50 (74.6) | 0.201 |
Hyperlipemia, n (%) | 214 (26.9) | 103 (35.3) | 0.005 | 38 (56.7) | 39 (58.2) | 0.500 |
Cigarette smoking, n (%) | 101 (12.7) | 25 (8.6) | 0.035 | 11 (16.4) | 10 (14.9) | 0.500 |
Active treatments | ||||||
β-blokers, n (%) | 266 (33.4) | 106 (36.3) | 0.207 | 39 (58.2) | 33 (49.3) | 0.193 |
ACE inhibitors, n (%) | 224 (28.1) | 61 (20.9) | 0.009 | 20(29.9) | 17 (25.4) | 0.139 |
Angiotens inreceptorblokers, n (%) | 289 (36.3) | 127 (43.5) | 0.019 | 29(43.3) | 29 (43.3) | 0.569 |
Calcium inhibitor, n (%) | 197 (24.7) | 51 (17.5) | 0.006 | 8 (11.9) | 12 (17.9) | 0.234 |
Nitrate, n (%) | 396 (49.7) | 141 (48.3) | 0.360 | 40 (59.7) | 35 (52.2) | 0.243 |
Statins, n (%) | 179 (22.5) | 83 (28.4) | 0.027 | 32 (47.8) | 29 (43.3) | 0.364 |
Thiazidediuretic, n (%) | 88 (11.1) | 16 (5.5) | 0.003 | 7 (10.4) | 8 (11.9) | 0.500 |
Insulin, n (%) | – | 67 (23.5) | – | 27 (25.2) | 26 (24.3) | 0.507 |
Meftformin, n (%) | – | 250 (87.7) | – | 94 (87.8) | 95 (88.8) | 0.124 |
Sulfonylureas, n (%) | – | 57 (20.0) | – | 22 (20.1) | 23 (21.5) | 0.177 |
Acarbose, n (%) | – | 31 (10.9) | – | 12 (11.2) | 11 (10.3) | 0.252 |
Thiazolidinediones, n (%) | – | 17 (5.9) | – | 6 (5.6) | 7 (6.5) | 0.098 |
GLP-1agonists, n (%) | – | 51 (17.9) | – | – | 23 (21.5) | – |
DPP-4inhibitors, n (%) | – | 142 (49.8) | – | – | 84 (78.5) | – |
Aspirin, n (%) | 228 (28.6) | 111 (38.0) | 0.002 | 30 (44.8) | 27 (40.3) | 0.363 |
Thienopyridine, n (%) | 81 (10.2) | 31 (10.6) | 0.455 | 8 (11.9) | 6 (9.0) | 0.389 |
Low-molecular heparin, n (%) | 38 (4.8) | 15 (5.1) | 0.456 | 4 (6.0) | 2 (3.0) | 0.340 |
Vitamin-Kantagonist, n (%) | 28 (3.5) | 6 (2.1) | 0.150 | 2 (3.0) | 2 (3.0) | 0.248 |
Laboratory analyses | ||||||
Plasma glucose (mg/dl) | 109.6 ± 17.5 | 201.8 ± 25.7 | 0.001 199.3 ± 29.6 202.9 ± 24.1 0.426 | 199.3 ± 29.6 | 202.9 ± 24.1 | 0.426 |
HbA1c (%) | 5.6 ± 1.1 | 8.7 ± 0.8 | 0.001 | 8.8 ± 0.72 | 8.9 ± 0.85 | 0.237 |
Cholesterol (mg/dl) | 205.5 ± 19.4 | 206.8 ± 24.6 | 0.361 | 204.0 ± 25.0 | 207.3 ± 19.0 | 0.386 |
LDL-cholesterol (mg/dl) | 130.4 ± 19.5 | 133.3 ± 23.9 | 0.039 | 130.0 ± 24.2 | 134.0 ± 24.1 | 0.284 |
HDL-cholesterol (mg/dl) | 38.6 ± 3.2 | 36.9 ± 3.5 | 0.001 | 37.2 ± 3.8 | 36.8 ± 3.5 | 0.556 |
Triglycerides (mg/dl) | 182.5 ± 19.5 | 188.8 ± 24.4 | 0.001 | 189.6 ± 23.5 | 188.2 ± 23.6 | 0.735 |
Creatinine (mg/dl) | 0.99 ± 0.15 | 0.98 ± 0.15 | 0.471 | 0.95 ± 0.17 | 0.98 ± 0.16 | 0.204 |
hs-cTnT (ng/l) | 14.8 ± 1.75 | 14.9 ± 2.5 | 0.216 | 15.0 ± 2.6 | 14.7 ± 1.5 | 0.557 |
HsC-reactive protein | 1.9 ± 0.3 | 4.0 ± 1.9 | 0.001 | 4.1 ± 0.9 | 1.2 ± 0.7 | 0.001 |
M1/M2ratio | 4.9 ± 2,6 | 15.8 ± 6.2 | 0.001 | 12.8 ± 2.4 | 5.5 ± 1.9 | 0.001 |
BasalGLP-1 (pmol/L) | 7.1 ± 1.1 | 4.9 ± 1.6 | 0.033 | 11.0 ± 2.1 | 15.3 ± 4.8 | 0.001 |
PostprandialGLP-1 (pmol/L) | 26.8 ± 4.1 | 13.9 ± 6.7 | 0.001 | 11.3 ± 2.2 | 15.3 ± 4.8 | 0.001 |
LVEF, n (%) | ||||||
> 50% | 516 (64.8) | 198 (67.8) | 0.199 38 (56.7) 42 (62.7) 0.299 | 38 (56.7) | 42 (62.7) | 0.299 |
41–50% | 233 (29.3) | 81 (27.7) | 0.339 | 25 (37.3) | 20 (29.9) | 0.232 |
25–40% | 47 (5.9) | 13 (4.5) | 0.220 | 4 (6.0) | 5 (7.5) | 0.500 |
Procedural data | ||||||
Symptom onset to angiography, h | 7.1 ± 1.2 | 6.9 ± 0.8 | 0.004 | 7.0 ± 0.8 | 6.9 ± 0.8 | 0.180 |
Insulin infusion time, min | – | 41.6 ± 3.1 | – 41.6 ± 3.1/42.6 ± 2.9 43.2 ± 3.2 0.316 | 42.6 ± 2.9 | 43.2 ± 3.2 | 0.316 |
Angiographic data | ||||||
Quantitative angiographic data | ||||||
Culprit obstructive lesion | ||||||
Lesion length, mm | 20.2 ± 2.12 | 20.9 ± 2.02 | 0.376 20.6 ± 1.6 20.2 ± 2.4 0.522 | 20.6 ± 1.6 | 20.2 ± 2.4 | 0.522 |
Reference diameter, mm | 2.7 ± 0.3 | 2.8 ± 0.4 | 0.087 | 2.8 ± 0.5 | 2.7 ± 0. 6 | 0.485 |
MLD, | 1.0 ± 0.21 | 1.1 ± 0.12 | 0.121 | 1.1 ± 0.13 | 1.1 ± 0.11 | 0.807 |
MLD post (in-stent). mm | 2.7 ± 1.6 | 2.7 ± 0.3 | 0.335 | |||
No-culprit NOCS | ||||||
Number of vessels, n (%) | ||||||
1-VD | 346 (43.5) | 135 (46.2) | 0.228 | 66 (61.7) | 68 (63.5) | 0.218 |
2-VD | 257 (32.3) | 80 (27.4) | 0.070 | 36 (33.6) | 35 (32.7) | 0.355 |
3-VD | 193 (24.2) | 77 (26.4) | 0.260 | 5 (4.7) | 4 (3.7) | 0.335 |
Stenosis (%) | 43.8 ± 2.1 | 44.13.2 | 0.092 | 43.9 ± 1.9 | 44.5 ± 2.2 | 0.124 |
Lesion length, mm | 15.8 ± 3.1 | 15.8 ± 3.9 | 0.863 | 15.6 ± 3.5 | 16.1 ± 3.8 | 0.387 |
Reference diameter, mm | 2.8 ± 0.4 | 2.8 ± 0.5 | 0.283 | 2.7 ± 0.51 | 2.9 ± 0.56 | 0.104 |
MLD, mm | 1.8 ± 1.5 | 1.83 ± 1.14 | 0.733 | 1.8 ± 1.35 | 1.9 ± 2.35 | 0.667 |
FFR, pd/pa | 0.84 ± 0.028 | 0.82 ± 0.019 | 0.189 | 0.84 ± 0.017 | 0.83 ± 0.019 | 0.889 |
Non-diabetic patients | Diabetic patients | p | PSM-diabetic never incretinusers | PSM-diabetic current incretinusers | p | |
---|---|---|---|---|---|---|
N | 796 | 292 | 67 | 67 | ||
All cause deaths | 9 (1.1%) | 6 (2.2%) | 0.05 | 3 (4.5%) | 3 (4.5%) | / |
Cardiac deaths | 39 (0.5%) | 5 (1.6%) | 0.045 | 3 (4.5%) | 2 (3.0%) | / |
MACE | 47 (5.9%) | 38 (12.9%) | 0.001 | 9 (12.9%) | 5 (7.4%) | 0.04 |
Univariate analysis | Multivariate analysis | |||
---|---|---|---|---|
HR (95% CI) | p value | HR (95% CI) | p value | |
A. Multivariate cox regression analysis for parameters associated with all cause deaths | ||||
Diabetes | 1.603 [0.919–2.797] | 0.097 | 2.172 [1.225–3.925] | 0.010* |
Hypertension | 0.658 [0.407–1.064] | 0.088 | 1.519 [0.926–2.492] | 0.098 |
Dyslipidemia | 0.906 [0.531–1.544] | 0.716 | 1.232 [0.715–2.122] | 0.452 |
Smoke | 1.784 [1.119–2.844] | 0.045 | 1.133 [0.694–1.851] | 0.621 |
LVEF < 50% | 1.176 [0.727–1.901] | 0.51 | 0.901 [0.558–1.453] | 0.669 |
Bas.Lesion length | 0.953 [0.849–1.070] | 0.415 | 0.973 [0.866–1.092] | 0.638 |
Obesity | 0.964 [0.529–1.758] | 0.906 | 0.952 [0.493–1.841] | 0.885 |
Incretin | 0.901 [0.528–1.535] | 0.700 | 1.274 [0.664–2.447] | 0.466 |
VD-3 | 0.859 [0.493–1.497] | 0.592 | 1.284 [0.727–2.268] | 0.389 |
HsCRP | 1.188 [0.545–2.191] | 0.665 | 0.623 [0.011–3.247] | 0.858 |
M1/M2 ratio | 0.958 [0.438–2.088] | 0.913 | 1.136 [0.319–3.221] | 0.922 |
LowGLP-1 | 0.901 [0.413–1.965] | 0.793 | 3.714 [0.215–4.902] | 0.922 |
B. Multivariate cox regression analysis is for parameters associated with cardiac deaths | ||||
Diabetes | 1.663 [0.951–2.908] | 0.075 | 2.253 [1.245–4.078] | 0.007* |
Hypertension | 0.705 [0.433–1.146] | 0.159 | 1.438 [0.871–2.375] | 0.155 |
Dyslipidemia | 0.959 [0.561–1.642] | 0.88 | 1.174 [0.679–2.031] | 0.565 |
Smoke | 1.757 [1.092–2.828] | 0.02 | 1.024 [0.626–1.675] | 0.924 |
LVEF < 50% | 1.049 [0.653–1.386] | 0.842 | 0.877 [0.538–1.430] | 0.601 |
Bas.Lesion length | 0.942 [0.837–1.061] | 0.326 | 0.961 [0.853–1.081] | 0.638 |
Obesity | 1.017 [0.556–1.860] | 0.956 | 0.859 [0.441–1.673] | 0.656 |
Incretin | 0.816 [0.466–1.427] | 0.475 | 1.531 [0.762–3.074] | 0.231 |
VD-3 | 0.838 [0.473–1.484] | 0.544 | 1.285 [0.716–2.308] | 0.401 |
HsCRP | 1.244 [0.569–2.117] | 0.584 | 7.546 [0.716–8.403] | 0.859 |
M1/M2 ratio | 1.003 [0.459–2.191] | 0.994 | 1.107 [0.011–4.934] | 0.991 |
LowGLP-1 | 0.944 [0.432–2.62] | 0.885 | 4.029 [0.028–4.802] | 0.823 |
C. Multivariate cox regression analysis is for parameters associated with major adverse cardiac events (MACE) | ||||
Diabetes | 0.952 [0.621–1.461] | 0.822 | 1.962 [1.124–3.422] | 0.018* |
Hypertension | 0.929 [0.678–1.274] | 0.649 | 1.058 [0.751–1.490] | 0.748 |
Dyslipidemia | 0.899 [0.634–1.275] | 0.55 | 1.148 [0.775–1.698] | 0.748 |
Smoke | 1.158 [0.839–1.598] | 0.372 | 0.829 [0.578–1.190] | 0.309 |
LVEF < 50% | 0.994 [0.725–1.363] | 0.969 | 0.277 [0.590–1.163] | 0.829 |
Bas.Lesion length | 1.032 [0.955-1.115] | 0.048 | 1.023 [0.930–1.126] | 0.637 |
Obesity | 0.320 [0.235-0.437] | 0.001 | 1.528 [0.509-2.204] | 0.064 |
Incretin | 0.257 [0.187–0.355] | 0.001 | 0.565 [0.387–0.824] | 0.003* |
VD-3 | 1.806 [1.167–2.794] | 0.008 | 1.173 [0.728–1.888] | 0.513 |
HsCRP | 35.947 [26.067–49.553] | 0.001 | 1.938 [0.908–4.137] | 0.087 |
M1/M2 ratio | 0.019 [0.014–0.027] | 0.001 | 0.773 [0.293–2.037] | 0.603 |
LowGLP-1 | 0.018 [0.012–0.025] | 0.001 | 1.528 [1.059–2.204] | 0.024* |