BACKGROUND/OBJECTIVES Pericoronary adipose tissue inflammation might lead to the development and destabilization of coronary plaques in prediabetic patients. Here, we evaluated inflammation and leptin to adiponectin ratio in pericoronary fat from patients subjected to coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI). Furthermore, we compared the 12-month prognosis of prediabetic patients compared to normoglycemic patients (NG). Finally, the effect of metformin therapy on pericoronary fat inflammation and 12-months prognosis in AMI-prediabetic patients was also evaluated. METHODS An observational prospective study was conducted on patients with first AMI referred for CABG. Participants were divided in prediabetic and NG-patients. Prediabetic patients were divided in two groups; never-metformin-users and current-metformin-users receiving metformin therapy for almost 6 months before CABG. During the by-pass procedure on epicardial coronary portion, the pericoronary fat was removed from the surrounding stenosis area. The primary endpoints were the assessments of Major-Adverse-Cardiac-Events (MACE) at 12-month follow-up. Moreover, inflammatory tone was evaluated by measuring pericoronary fat levels of tumor necrosis factor-α (TNF-α), sirtuin 6 (SIRT6), and leptin to adiponectin ratio. Finally, inflammatory tone was correlated to the MACE during the 12-months follow-up. RESULTS The MACE was 9.1% in all prediabetic patients and 3% in NG-patients. In prediabetic patients, current-metformin-users presented a significantly lower rate of MACE compared to prediabetic patients never-metformin-users. In addition, prediabetic patients showed higher inflammatory tone and leptin to adiponectin ratio in pericoronary fat compared to NG-patients (P < 0.001). Prediabetic never-metformin-users showed higher inflammatory tone and leptin to adiponectin ratio in pericoronary fat compared to current-metformin-users (P < 0.001). Remarkably, inflammatory tone and leptin to adiponectin ratio was significantly related to the MACE during the 12-months follow-up. CONCLUSION Prediabetes increase inflammatory burden in pericoronary adipose tissue. Metformin by reducing inflammatory tone and leptin to adiponectin ratio in pericoronary fat may improve prognosis in prediabetic patients with AMI. Trial registration Clinical Trial NCT03360981, Retrospectively Registered 7 January 2018.

中文翻译：

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糖尿病前期急性心肌梗死患者的冠状动脉脂肪炎症和主要不良心脏事件（MACE）：二甲双胍的作用。

背景/目的冠状动脉脂肪组织炎症可能导致糖尿病前期患者冠状动脉斑块的发展和不稳定。在这里，我们评估了急性冠状动脉搭桥术（CABG）患者急性心肌梗死（AMI）患者冠状动脉脂肪中的炎症和瘦素与脂联素的比率。此外，我们比较了糖尿病前期患者和正常血糖患者（NG）的12个月预后。最后，还评估了二甲双胍治疗对AMI糖尿病前期患者冠状动脉周围脂肪炎症和12个月预后的影响。方法对首例以CABG为主的AMI患者进行了一项观察性前瞻性研究。参与者分为糖尿病前期患者和NG患者。糖尿病前期患者分为两组。从未服用二甲双胍的患者和当前服用二甲双胍的用户在CABG之前已接受了近6个月的二甲双胍治疗。在心外膜冠状动脉部分的旁路手术过程中，冠状动脉周围的狭窄区域的冠状动脉脂肪被去除。主要终点是在12个月的随访中对重大不良心脏事件（MACE）的评估。此外，通过测量肿瘤坏死因子-α（TNF-α），sirtuin 6（SIRT6）和瘦素与脂联素之比的冠状动脉脂肪水平来评估炎症状态。最后，在12个月的随访期间，发炎的语气与MACE相关。结果所有糖尿病前期患者的MACE为9.1％，NG患者为3％。在糖尿病前期患者中，与从未服用过二甲双胍的患者相比，目前服用二甲双胍的患者的MACE发生率显着降低。此外，糖尿病前期患者与冠心病患者相比，冠状动脉脂肪中炎性基调和瘦素与脂联素的比率更高（P <0.001）。与目前使用二甲双胍的人相比，糖尿病前从未使用过二甲双胍的人在冠状动脉脂肪中显示出更高的发炎口气和瘦素与脂联素的比率（P <0.001）。值得注意的是，在12个月的随访中，炎症反应和瘦素与脂联素的比例与MACE显着相关。结论糖尿病前体会增加冠状动脉周围脂肪组织的炎性负担。二甲双胍可通过降低冠状动脉脂肪中的炎症性调和瘦素与脂联素的比率来改善糖尿病前期AMI患者的预后。试验注册临床试验NCT03360981，回顾性注册于2018年1月7日。