OBJECTIVES The aim of this study was to investigate the impact of pre-diabetes (pre-DM) on coronary plaque characteristics and ischemic outcomes in patients with acute coronary syndromes (ACS). BACKGROUND Pre-DM (i.e., the early stages of glucometabolic disturbance) is common among patients with ACS, but the extent to which pre-DM influences coronary plaque characteristics and the risk for adverse ischemic events is unclear. METHODS In the PROSPECT (Providing Regional Observations to Study Predictors of Events in Coronary Tree) study, patients with ACS underwent quantitative coronary angiography, grayscale intravascular ultrasound, and radiofrequency intravascular ultrasound after successful percutaneous coronary intervention. Patients were divided into 3 groups according to their glucometabolic status, as defined by the American Diabetes Association: normal glucose metabolism (NGM), pre-DM, and diabetes mellitus (DM). These groups were compared with regard to coronary plaque characteristics and the risk for major adverse cardiac events (MACEs) (defined as cardiac death or arrest, myocardial infarction, or rehospitalization for unstable or progressive angina). RESULTS Among 547 patients, 162 (29.6%) had NGM, 202 (36.9%) had pre-DM, and 183 (33.4%) had DM. There were no significant differences between the groups with regard to intravascular ultrasound findings indicative of vulnerable plaques. Patients with DM had a higher crude rate of MACEs than those with pre-DM or NGM (25.9% vs. 16.3% and 16.1%; p = 0.03 and p = 0.02, respectively). In an adjusted Cox regression model using NGM as the reference group, DM (hazard ratio: 2.20; 95% confidence interval: 1.25 to 3.86; p = 0.006) but not pre-DM (hazard ratio: 1.29; 95% confidence interval: 0.71 to 2.33; p = 0.41) was associated with increased risk for MACEs. CONCLUSIONS Impaired glucose metabolism is common among patients presenting with ACS. DM but not pre-DM is associated with an increased risk for MACEs. Thus, preventing patients from progressing from pre-DM to DM is important. (PROSPECT: An Imaging Study in Patients With Unstable Atherosclerotic Lesions; NCT00180466).

中文翻译：

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糖尿病前期对急性冠脉综合征患者冠状动脉斑块组成和临床结果的影响：来自PROSPECT研究的分析。

目的本研究的目的是研究糖尿病前期（pre-DM）对急性冠脉综合征（ACS）患者冠状动脉斑块特征和缺血结局的影响。背景技术DM前期（即，糖代谢紊乱的早期阶段）在ACS患者中很常见，但是前DM在多大程度上影响冠状动脉斑块特征以及不良缺血事件的风险尚不清楚。方法在PROSPECT（为研究冠状动脉事件的预测因素提供区域观察）研究中，ACS患者在成功地经皮冠状动脉介入治疗后进行了定量冠状动脉造影，灰度血管内超声和射频血管内超声检查。根据患者的糖代谢状况将其分为三组，根据美国糖尿病协会的定义：正常葡萄糖代谢（NGM），DM前和糖尿病（DM）。比较了这些组的冠状动脉斑块特征和主要不良心脏事件（MACE）（定义为心源性死亡或停搏，心肌梗塞或因不稳定或进行性心绞痛而住院治疗）的风险。结果在547名患者中，有162名（29.6％）患有NGM，有202名（36.9％）患有DM前期，有183名（33.4％）患有DM。两组之间在血管内超声检查结果表明易损斑块方面无显着差异。DM患者的MACE原始率高于DM前或NGM的患者（分别为25.9％，16.3％和16.1％； p = 0.03和p = 0.02）。在以NGM为参考组的调整后的Cox回归模型中，DM（危险比：2.20；95％置信区间：1.25至3.86; p = 0.006）而非DM前（危险比：1.29； 95％置信区间：0.71至2.33； p = 0.41）与MACE风险增加相关。结论ACS患者中葡萄糖代谢异常是常见的。DM而非pre-DM与MACE风险增加相关。因此，防止患者从DM前发展到DM很重要。（前景：对不稳定的动脉粥样硬化病变患者的影像学研究； NCT00180466）。防止患者从DM前发展到DM很重要。（前景：对不稳定的动脉粥样硬化病变患者的影像学研究； NCT00180466）。防止患者从DM前发展到DM很重要。（前景：对不稳定的动脉粥样硬化病变患者的影像学研究； NCT00180466）。