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Impact of Hyperinsulinemia on Long-Term Clinical Outcomes of Percutaneous Coronary Intervention in Patients without Diabetes Who Have Acute Myocardial Syndrome
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy ( IF 2.8 ) Pub Date : 2021-09-07 , DOI: 10.2147/dmso.s318852 Qiang Tan 1 , Ming Chen 1 , Jia Hao 1 , Kun Wei 1
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy ( IF 2.8 ) Pub Date : 2021-09-07 , DOI: 10.2147/dmso.s318852 Qiang Tan 1 , Ming Chen 1 , Jia Hao 1 , Kun Wei 1
Affiliation
Background and Objectives: Hyperinsulinemia plays a key role in the development of cardiovascular impairment in patients with metabolic syndrome. The aim of this study was to evaluate the influence of hyperinsulinemia on long-term clinical outcomes of percutaneous coronary intervention (PCI) in patients without diabetes mellitus who have acute myocardial syndrome (ACS).
Methods: Between March 2016 and January 2019, we enrolled 468 patients with ACS and without diabetes mellitus who received primary PCI. Patients were divided into a low-insulin group (n = 157), medium-insulin group (n = 154), and high-insulin group (n = 157) according to tertiles of fasting insulin level. The primary endpoint was major adverse cardiac events (MACE; all-cause death, non-fatal myocardial infarction, target vessel revascularization [TVR]) at 24 months. The secondary endpoint was angina hospitalization.
Results: Patients in the high-insulin group had an unfavorable prognosis, with a higher rate of MACE (34.39%) than the low-insulin group (22.29%) and medium-insulin group (23.37%) at 24 months (P < 0.05). This difference was mainly driven by the increase in TVR. The high-insulin group also had a higher rate of angina hospitalization than the low-insulin group. Cox proportional hazards regression showed that high-insulin level (hazard ratio [HR] 1.870, 95% confidence interval [CI] 1.202– 2.909), small-vessel lesion (HR 1.713, 95% CI 1.111– 2.642), bifurcation lesion (HR 3.394, 95% CI 2.033– 5.067), SYNTAX score (HR 1.084, 95% CI 1.039– 1.130), and stent length (HR 1.017, 95% CI 1.002– 1.032) increased the incidence of MACE in patients with ACS and without diabetes who underwent PCI.
Conclusion: Hyperinsulinemia might be a valid predictor of clinical outcomes in patients with ACS undergoing PCI.
Keywords: percutaneous coronary intervention, hyperinsulinemia, acute myocardial syndrome, major adverse cardiac events
中文翻译：
高胰岛素血症对患有急性心肌综合征的非糖尿病患者经皮冠状动脉介入治疗的长期临床结果的影响
背景和目的：高胰岛素血症在代谢综合征患者心血管损害的发展中起关键作用。本研究的目的是评估高胰岛素血症对患有急性心肌综合征 (ACS) 的非糖尿病患者经皮冠状动脉介入治疗 (PCI) 长期临床结果的影响。
方法：在 2016 年 3 月至 2019 年 1 月期间，我们招募了 468 名接受直接 PCI 的 ACS 和无糖尿病患者。根据空腹胰岛素水平的三分位数将患者分为低胰岛素组（n = 157）、中胰岛素组（n = 154）和高胰岛素组（n = 157）。主要终点是 24 个月时的主要不良心脏事件（MACE；全因死亡、非致死性心肌梗死、靶血管血运重建 [TVR]）。次要终点是心绞痛住院。
结果：高胰岛素组患者预后不良，24个月时MACE发生率（34.39%）高于低胰岛素组（22.29%）和中胰岛素组（23.37%）（P < 0.05）。这种差异主要是由于 TVR 的增加所致。高胰岛素组的心绞痛住院率也高于低胰岛素组。Cox 比例风险回归显示高胰岛素水平（风险比 [HR] 1.870，95% 置信区间 [CI] 1.202–2.909），小血管病变（HR 1.713，95% CI 1.111–2.642），分叉病变（HR 3.394, 95% CI 2.033–5.067)、SYNTAX 评分 (HR 1.084, 95% CI 1.039–1.130) 和支架长度 (HR 1.017, 95% CI 1.002–1.032) 增加了 ACS 和非糖尿病患者的 MACE 发生率谁接受了PCI。
结论：高胰岛素血症可能是接受 PCI 的 ACS 患者临床结果的有效预测因子。
【关键词】：经皮冠状动脉介入治疗 高胰岛素血症 急性心肌综合征 主要心脏不良事件
更新日期：2021-09-07
Methods: Between March 2016 and January 2019, we enrolled 468 patients with ACS and without diabetes mellitus who received primary PCI. Patients were divided into a low-insulin group (n = 157), medium-insulin group (n = 154), and high-insulin group (n = 157) according to tertiles of fasting insulin level. The primary endpoint was major adverse cardiac events (MACE; all-cause death, non-fatal myocardial infarction, target vessel revascularization [TVR]) at 24 months. The secondary endpoint was angina hospitalization.
Results: Patients in the high-insulin group had an unfavorable prognosis, with a higher rate of MACE (34.39%) than the low-insulin group (22.29%) and medium-insulin group (23.37%) at 24 months (P < 0.05). This difference was mainly driven by the increase in TVR. The high-insulin group also had a higher rate of angina hospitalization than the low-insulin group. Cox proportional hazards regression showed that high-insulin level (hazard ratio [HR] 1.870, 95% confidence interval [CI] 1.202– 2.909), small-vessel lesion (HR 1.713, 95% CI 1.111– 2.642), bifurcation lesion (HR 3.394, 95% CI 2.033– 5.067), SYNTAX score (HR 1.084, 95% CI 1.039– 1.130), and stent length (HR 1.017, 95% CI 1.002– 1.032) increased the incidence of MACE in patients with ACS and without diabetes who underwent PCI.
Conclusion: Hyperinsulinemia might be a valid predictor of clinical outcomes in patients with ACS undergoing PCI.
Keywords: percutaneous coronary intervention, hyperinsulinemia, acute myocardial syndrome, major adverse cardiac events
中文翻译：
高胰岛素血症对患有急性心肌综合征的非糖尿病患者经皮冠状动脉介入治疗的长期临床结果的影响
背景和目的：高胰岛素血症在代谢综合征患者心血管损害的发展中起关键作用。本研究的目的是评估高胰岛素血症对患有急性心肌综合征 (ACS) 的非糖尿病患者经皮冠状动脉介入治疗 (PCI) 长期临床结果的影响。
方法：在 2016 年 3 月至 2019 年 1 月期间，我们招募了 468 名接受直接 PCI 的 ACS 和无糖尿病患者。根据空腹胰岛素水平的三分位数将患者分为低胰岛素组（n = 157）、中胰岛素组（n = 154）和高胰岛素组（n = 157）。主要终点是 24 个月时的主要不良心脏事件（MACE；全因死亡、非致死性心肌梗死、靶血管血运重建 [TVR]）。次要终点是心绞痛住院。
结果：高胰岛素组患者预后不良，24个月时MACE发生率（34.39%）高于低胰岛素组（22.29%）和中胰岛素组（23.37%）（P < 0.05）。这种差异主要是由于 TVR 的增加所致。高胰岛素组的心绞痛住院率也高于低胰岛素组。Cox 比例风险回归显示高胰岛素水平（风险比 [HR] 1.870，95% 置信区间 [CI] 1.202–2.909），小血管病变（HR 1.713，95% CI 1.111–2.642），分叉病变（HR 3.394, 95% CI 2.033–5.067)、SYNTAX 评分 (HR 1.084, 95% CI 1.039–1.130) 和支架长度 (HR 1.017, 95% CI 1.002–1.032) 增加了 ACS 和非糖尿病患者的 MACE 发生率谁接受了PCI。
结论：高胰岛素血症可能是接受 PCI 的 ACS 患者临床结果的有效预测因子。
【关键词】：经皮冠状动脉介入治疗 高胰岛素血症 急性心肌综合征 主要心脏不良事件
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