Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61
Abstract Background Hyperglycemia in the setting of an acute coronary syndrome (ACS) impacts short term outcomes, but little is known about longer term effects. We therefore designed this study to firstly determine the association between hyperglycemia and short term and longer term outcomes in pati...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-10-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12933-019-0946-6 |
| _version_ | 1818266928457711616 |
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| author | Patric Winzap Allan Davies Roland Klingenberg Slayman Obeid Marco Roffi François Mach Lorenz Räber Stephan Windecker Christian Templin Fabian Nietlispach David Nanchen Baris Gencer Olivier Muller Christian M. Matter Arnold von Eckardstein Thomas F. Lüscher |
| author_facet | Patric Winzap Allan Davies Roland Klingenberg Slayman Obeid Marco Roffi François Mach Lorenz Räber Stephan Windecker Christian Templin Fabian Nietlispach David Nanchen Baris Gencer Olivier Muller Christian M. Matter Arnold von Eckardstein Thomas F. Lüscher |
| author_sort | Patric Winzap |
| collection | DOAJ |
| description | Abstract Background Hyperglycemia in the setting of an acute coronary syndrome (ACS) impacts short term outcomes, but little is known about longer term effects. We therefore designed this study to firstly determine the association between hyperglycemia and short term and longer term outcomes in patients presenting with ACS and secondly evaluate the prognostic role of diabetes, body mass index (BMI) and the novel biomarker Cyr61 on outcomes. Methods The prospective Special Program University Medicine-Acute Coronary Syndrome (SPUM-ACS) cohort enrolled 2168 patients with ACS between December 2009 and October 2012, of which 2034 underwent PCI (93.8%). Patients were followed up for 12 months. Events were independently adjudicated by three experienced cardiologists. Participants were recruited from four tertiary hospitals in Switzerland: Zurich, Geneva, Lausanne and Bern. Participants presenting with acute coronary syndromes and who underwent coronary angiography were included in the analysis. Patients were grouped according to history of diabetes (or HbA1c greater than 6%), baseline blood sugar level (BSL; < 6, 6–11.1 and > 11.1 mmol/L) and body mass index (BMI). The primary outcome was major adverse cardiac events (MACE) which was a composite of myocardial infarction, stroke and all-cause death. Secondary outcomes included the individual components of the primary endpoint, revascularisations, bleeding events (BARC classification) and cerebrovascular events (ischaemic or haemorrhagic stroke or TIA). Results Patients with hyperglycemia, i.e. BSL ≥ 11.1 mmol/L, had higher levels of C-reactive protein (CRP), white blood cell count (WBC), creatinine kinase (CK), higher heart rates and lower left ventricular ejection fraction (LVEF) and increased N-terminal pro-brain natriuretic peptide. At 30 days and 12 months, those with BSL ≥ 11.1 mmol/L had more MACE and death compared to those with BSL < 6.0 mmol/L or 6.0–11.1 mmol/L (HR-ratio 4.78 and 6.6; p < 0.001). The novel biomarker Cyr61 strongly associated with high BSL and STEMI and was independently associated with 1 year outcomes (HR 2.22; 95% CI 1.33–3.72; Tertile 3 vs. Tertile 1). Conclusions and relevance In this large, prospective, independently adjudicated cohort of in all comers ACS patients undergoing PCI, both a history of diabetes and elevated entry glucose was associated with inflammation and increased risk of MACE both at short and long-term. The mediators might involve increased sympathetic activation, inflammation and ischemia as reflected by elevated Cyr61 levels leading to larger levels of troponin and lower LVEF. Trial registration Clinical Trial Registration Number: NCT01000701. Registered October 23, 2009 |
| first_indexed | 2024-12-12T20:14:30Z |
| format | Article |
| id | doaj.art-ed36ab11b429427d82e7c4ef5e194d86 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-12-12T20:14:30Z |
| publishDate | 2019-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-ed36ab11b429427d82e7c4ef5e194d862022-12-22T00:13:25ZengBMCCardiovascular Diabetology1475-28402019-10-0118111010.1186/s12933-019-0946-6Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61Patric Winzap0Allan Davies1Roland Klingenberg2Slayman Obeid3Marco Roffi4François Mach5Lorenz Räber6Stephan Windecker7Christian Templin8Fabian Nietlispach9David Nanchen10Baris Gencer11Olivier Muller12Christian M. Matter13Arnold von Eckardstein14Thomas F. Lüscher15Center for Molecular Cardiology, University of ZurichRoyal Brompton and Harefield Hospitals and Imperial CollegeDepartment of Cardiology, Kerckhoff Heart and Thorax CenterDepartment of Cardiology, University Heart Center Zurich, University Hospital ZurichDepartment of Cardiology, Hopital Universitaire de GeneveDepartment of Cardiology, Hopital Universitaire de GeneveDepartment of Cardiology, Swiss Heart Centre, InselspitalDepartment of Cardiology, Swiss Heart Centre, InselspitalDepartment of Cardiology, University Heart Center Zurich, University Hospital ZurichDepartment of Cardiology, University Heart Center Zurich, University Hospital ZurichCenter for Primary Care and Public Health (Unisanté), University of LausanneDepartment of Cardiology, Hopital Universitaire de GeneveService of Cardiology, Centre Hospitalier Universitaire VaudoisCenter for Molecular Cardiology, University of ZurichInstitute of Clinical Chemistry, University Hospital ZurichCenter for Molecular Cardiology, University of ZurichAbstract Background Hyperglycemia in the setting of an acute coronary syndrome (ACS) impacts short term outcomes, but little is known about longer term effects. We therefore designed this study to firstly determine the association between hyperglycemia and short term and longer term outcomes in patients presenting with ACS and secondly evaluate the prognostic role of diabetes, body mass index (BMI) and the novel biomarker Cyr61 on outcomes. Methods The prospective Special Program University Medicine-Acute Coronary Syndrome (SPUM-ACS) cohort enrolled 2168 patients with ACS between December 2009 and October 2012, of which 2034 underwent PCI (93.8%). Patients were followed up for 12 months. Events were independently adjudicated by three experienced cardiologists. Participants were recruited from four tertiary hospitals in Switzerland: Zurich, Geneva, Lausanne and Bern. Participants presenting with acute coronary syndromes and who underwent coronary angiography were included in the analysis. Patients were grouped according to history of diabetes (or HbA1c greater than 6%), baseline blood sugar level (BSL; < 6, 6–11.1 and > 11.1 mmol/L) and body mass index (BMI). The primary outcome was major adverse cardiac events (MACE) which was a composite of myocardial infarction, stroke and all-cause death. Secondary outcomes included the individual components of the primary endpoint, revascularisations, bleeding events (BARC classification) and cerebrovascular events (ischaemic or haemorrhagic stroke or TIA). Results Patients with hyperglycemia, i.e. BSL ≥ 11.1 mmol/L, had higher levels of C-reactive protein (CRP), white blood cell count (WBC), creatinine kinase (CK), higher heart rates and lower left ventricular ejection fraction (LVEF) and increased N-terminal pro-brain natriuretic peptide. At 30 days and 12 months, those with BSL ≥ 11.1 mmol/L had more MACE and death compared to those with BSL < 6.0 mmol/L or 6.0–11.1 mmol/L (HR-ratio 4.78 and 6.6; p < 0.001). The novel biomarker Cyr61 strongly associated with high BSL and STEMI and was independently associated with 1 year outcomes (HR 2.22; 95% CI 1.33–3.72; Tertile 3 vs. Tertile 1). Conclusions and relevance In this large, prospective, independently adjudicated cohort of in all comers ACS patients undergoing PCI, both a history of diabetes and elevated entry glucose was associated with inflammation and increased risk of MACE both at short and long-term. The mediators might involve increased sympathetic activation, inflammation and ischemia as reflected by elevated Cyr61 levels leading to larger levels of troponin and lower LVEF. Trial registration Clinical Trial Registration Number: NCT01000701. Registered October 23, 2009http://link.springer.com/article/10.1186/s12933-019-0946-6Acute coronary syndromesDiabetesGlucoseInflammationMajor cardiovascular and cerebrovascular eventsMortality |
| spellingShingle | Patric Winzap Allan Davies Roland Klingenberg Slayman Obeid Marco Roffi François Mach Lorenz Räber Stephan Windecker Christian Templin Fabian Nietlispach David Nanchen Baris Gencer Olivier Muller Christian M. Matter Arnold von Eckardstein Thomas F. Lüscher Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61 Cardiovascular Diabetology Acute coronary syndromes Diabetes Glucose Inflammation Major cardiovascular and cerebrovascular events Mortality |
| title | Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61 |
| title_full | Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61 |
| title_fullStr | Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61 |
| title_full_unstemmed | Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61 |
| title_short | Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61 |
| title_sort | diabetes and baseline glucose are associated with inflammation left ventricular function and short and long term outcome in acute coronary syndromes role of the novel biomarker cyr 61 |
| topic | Acute coronary syndromes Diabetes Glucose Inflammation Major cardiovascular and cerebrovascular events Mortality |
| url | http://link.springer.com/article/10.1186/s12933-019-0946-6 |
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