Glycemic Variability on Continuous Glucose Monitoring System Predicts Rapid Progression of Non-Culprit Lesions in Patients With Acute Coronary Syndrome

• Published in: Circulation Journal Vol. 79; no. 10; pp. 2246 - 2254
• Main Authors: Kataoka, Shunsuke, Gohbara, Masaomi, Iwahashi, Noriaki, Sakamaki, Kentaro, Nakachi, Tatsuya, Akiyama, Eiichi, Maejima, Nobuhiko, Tsukahara, Kengo, Hibi, Kiyoshi, Kosuge, Masami, Ebina, Toshiaki, Umemura, Satoshi, Kimura, Kazuo
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2015
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - blood; Acute Coronary Syndrome - physiopathology; Aged; Blood Glucose - metabolism; Female; Glycemic variability; Humans; Male; Middle Aged; Monitoring, Physiologic; Prospective Studies; Rapid progression
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-15-0496

Background:Although rapid progression (RP) of coronary artery disease (CAD) has been shown to be a powerful predictor of cardiovascular events, predictors of RP are not fully understood in patients with acute coronary syndrome (ACS).Methods and Results:We prospectively investigated the clinical impact of glycemic variability (GV), as determined on continuous glucose monitoring system (CGMS), on RP of non-culprit lesions in 88 patients with ACS. RP was defined as ≥10% diameter reduction in a pre-existing stenosis ≥50%; ≥30% diameter reduction in a stenosis <50%; development of a new stenosis ≥30% in a previously normal segment; or progression of any stenosis to total occlusion. Patients were classified into 2 groups according to the presence (progressor, n=20) or absence (non-progressor, n=68) of RP. All patients were equipped with a CGMS during the stable phase, and mean amplitude of glycemic excursion (MAGE) was calculated as a marker of GV. Mean MAGE was significantly higher in progressors than in non-progressors (55±19 mg/dl vs. 37±18 mg/dl, P<0.01). On multiple logistic regression analysis, MAGE was an independent predictor of RP (odds ratio, 1.06 per 1 mg/dl; P<0.01).Conclusions:MAGE early after the onset of ACS is a predictor of RP of non-culprit lesions. (Circ J 2015; 79: 2246–2254)