The relationship between glycemic risk and longitudinal changes in total physiological atherosclerotic burden in patients with coronary artery disease

Jiapeng Chu; Yan Lai; Yian Yao; Wen Ye; Tongqing Yao; Hao Lin; Deqiang Yuan; Fan Ping; Guoqi Zhu; Haoran Ding; Fei Chen; Wenwen Yan; Xuebo Liu

doi:10.21037/qims-23-1160

The relationship between glycemic risk and longitudinal changes in total physiological atherosclerotic burden in patients with coronary artery disease

Quant Imaging Med Surg. 2024 Apr 3;14(4):2904-2915. doi: 10.21037/qims-23-1160. Epub 2024 Jan 17.

Authors

Jiapeng Chu¹, Yan Lai¹, Yian Yao¹, Wen Ye¹, Tongqing Yao¹, Hao Lin¹, Deqiang Yuan¹, Fan Ping¹, Guoqi Zhu¹, Haoran Ding¹, Fei Chen¹, Wenwen Yan¹, Xuebo Liu¹

Affiliation

¹ Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.

Abstract

Background: The effects of glycemic status on coronary physiology have not been well evaluated. This study aimed to investigate changes in coronary physiology by using angiographic quantitative flow ratio (QFR), and their relationships with diabetes mellitus (DM) and glycemic control status.

Methods: This retrospective cohort study included 530 patients who underwent serial coronary angiography (CAG) measurements between January 2016 and December 2021 at Tongji Hospital of Tongji University. Based on baseline and follow-up angiograms, 3-vessel QFR (3V-QFR) measurements were performed. Functional progression of coronary artery disease (CAD) was defined as a change in 3V-QFR (Δ3V-QFR = 3V-QFR_follow-up - 3V-QFR_baseline) ≤-0.05. Univariable and multivariable logistic regression analyses were applied to identify the independent predictors of coronary functional progression. Subgroup analysis according to diabetic status was performed.

Results: During a median interval of 12.1 (10.6, 14.3) months between the two QFR measurements, functional progression was observed in 169 (31.9%) patients. Follow-up glycosylated hemoglobin (HbA1c) was predictive of coronary functional progression with an area under the curve (AUC) of 0.599 [95% confidence interval (CI): 0.546-0.651; P<0.001] in the entire population. Additionally, the Δ3V-QFR values were significantly lower in diabetic patients with HbA1c ≥7.0% compared to those with well-controlled HbA1c or non-diabetic patients [-0.03 (-0.09, 0) vs. -0.02 (-0.05, 0.01) vs. -0.02 (-0.05, 0.02); P=0.002]. In a fully adjusted multivariable logistics analysis, higher follow-up HbA1c levels were independently associated with progression in 3V-QFR [odds ratio (OR), 1.263; 95% CI: 1.078-1.479; P=0.004]. Furthermore, this association was particularly strong in diabetic patients (OR, 1.353; 95% CI: 1.082-1.693; P=0.008) compared to patients without DM.

Conclusions: Among patients with established CAD, on-treatment HbA1c levels were independently associated with progression in physiological atherosclerotic burden, especially in patients with DM.

Keywords: Plaque progression; coronary angiography (CAG); diabetes mellitus (DM); quantitative flow ratio (QFR).