Impact Of Pre- And Post-Intervention Glucose On The Severity And Prognosis Of Coronary Lesions In Patients With Diabetes And CHD

Background:Patients with diabetes mellitus(DM)were at higher risk of developing coronary heart disease(CHD),and had a worse prognosis compared to non-diabetic patients.Objective:To develop a diagnostic prediction model for CHD to predict the risk of developing CHD in DM patients.Investigate the relationship between the level of pre-interventional glucose and the severity of coronary stenosis and the risk of CHD.And investigate the impact of pre-and post-intervention glucose and glucoselowering regimens on the prognosis of CHD.Methods:This was a retrospective cohort study with DM,who underwent first coronary angiography(CAG)at the Second Affiliated Hospital of Nanchang University from October 2017 to October 2021.Independent prognostic factors of the risk of CHD were identified by Logistic regression model and used in the nomogram.Logistics regression model was used to analysis the relationship between pre-intervention glycated hemoglobin A1c(Hb A1c)levels and the risk of CHD and the severity of coronary stenosis.The impact of pre-and post-intervention Hb A1 c and glucoselowering regimens on the prognosis of CHD was assessed using the COX proportional risk model.Results:(1)A total of 469 DM patients were included,303 DM with CHD and 166 DM with non-CHD.Independent prognostic factors,including low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),estimated glomerular filtration rate(e GFR),Hb A1 c,gender,age,and systolic blood pressure(SBP)were identified by Logistic regression model and used in the nomogram.Development of a diagnostic prediction model for CHD to predict the risk of developing CHD in DM patients.And the model has good predictive performance(AUC =0.734,95%CI 0.68-0.78).(2)Pre-intervention Hb A1 c was positively associated with the risk of CHD(OR= 1.40,95% CI 1.21-1.61,p < 0.001)and the severity of coronary stenosis(r=0.207,p <0.001).Compared with pre-intervention Hb A1 c ≤6%,patients with Hb A1 c >9% had more serious coronary stenosis(estimate = 2.67,p = 0.003).(3)The HR for the association between pre-and post-intervention Hb A1 c and the prognosis for the risk of 3-point Major Adverse Cardiac Event(3p-MACE)in patients with DM combined with CHD was 1.24(95% CI 0.94-1.64,p = 0.123)and1.32(95% CI 1.02-1.72,p = 0.036).Compared with post-intervention Hb A1c<8.6%(HR=0.59,95% CI 0.34-1.03,p = 0.065),patients with Hb A1 c > 8.6% had higher risk of 3p-MACE after interventions(HR=1.79,95% CI 1.16-2.79,p = 0.009).(4)For patients with DM combined with CHD,treatment with insulin had a higher prognostic risk of 3p-MACE than non-insulin treatment,HR= 2.49(95% CI1.14-5.42,p = 0.022).Conclusion:This study found that pre-intervention Hb A1 c levels were positively associated with the risk of CHD and the severity of coronary stenosis of DM patients.However,pre-intervention Hb A1 c was not related to the prognosis of CHD,which was related to post-intervention glycemic control.Controlling Hb A1 c levels below 8.6% at 21 months after intervention significantly reduces the prognostic risk of adverse cardiovascular events.