Impact of insulin resistance on post-procedural myocardial injury and clinical outcomes in patients who underwent elective coronary interventions with drug-eluting stents
Tadayuki Uetani, Tetsuya Amano, Kazuhiro Harada, Katsuhide Kitagawa, Ayako Kunimura, Yusaku Shimbo, Ken Harada, Tomohiro Yoshida, Bunichi Kato, Masataka Kato, Nobuyuki Marui, Michio Nanki, Nigishi Hotta, Hideki Ishii, Tatsuaki Matsubara, Toyoaki Murohara, Tadayuki Uetani, Tetsuya Amano, Kazuhiro Harada, Katsuhide Kitagawa, Ayako Kunimura, Yusaku Shimbo, Ken Harada, Tomohiro Yoshida, Bunichi Kato, Masataka Kato, Nobuyuki Marui, Michio Nanki, Nigishi Hotta, Hideki Ishii, Tatsuaki Matsubara, Toyoaki Murohara
Abstract
Objectives: This study sought to evaluate the associations between homeostatic indexes of insulin resistance (HOMA-IR) and post-procedural myocardial injury and clinical outcome after a percutaneous coronary intervention (PCI) with a drug-eluting stent.
Background: Insulin resistance increases the risk of cardiovascular events. However, the association between insulin resistance and clinical outcome after coronary intervention is unclear.
Methods: We evaluated 516 consecutive patients who underwent elective PCI with drug-eluting stents. Blood samples were collected from venous blood after overnight fasting, and fasting plasma glucose and insulin levels were measured. HOMA-IR was calculated according to the homeostasis model assessment. Post-procedural myocardial injury was evaluated by analysis of troponin T and creatine kinase-myocardial band isozyme levels hours after PCI. Cardiac event was defined as the composite endpoint of cardiovascular death, myocardial infarction, and any revascularization.
Results: With increasing tertiles of HOMA-IR, post-procedural troponin T and creatine kinase-myocardial band levels increased. In the multiple regression analysis, HOMA-IR was independently associated with troponin T elevation. During a median follow-up of 623 days, patients with the highest tertiles of HOMA-IR had the highest risk of cardiovascular events. The Cox proportional hazard models identified HOMA-IR as independently associated with worse clinical outcome after adjustment for clinical and procedural factors.
Conclusions: These results indicated the impact of insulin resistance on post-procedural myocardial injury and clinical outcome after elective PCI with drug-eluting stent deployment. Evaluation of insulin resistance may provide useful information for predicting clinical outcomes after elective PCI.
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed