The association of pre-diabetes with significant coronary artery disease and ischemic mitral regurgitation in patients with non-ST-segment elevation acute coronary syndrome

Background

Pre-diabetes is associated with an increased risk of developing cardiovascular disease (CVD). We aimed to investigate the association between pre-diabetes and the severity of coronary artery disease, along with other high-risk markers—such as ischemic mitral regurgitation (MR)—in non-diabetic patients hospitalized with NSTE-ACS.

Methods

This study was a case control study on 200 non-diabetic patients including equal size of consecutive pre-diabetic and normoglycemic individuals with NSTE-ACS. All patients underwent an echocardiography to determine the left ventricular ejection fraction, prevalence and existence of ischemic mitral regurgitation (MR), and right ventricular size and function. After that, coronary angiography (CAG) was performed to assess the significance of coronary artery disease (CAD) and to calculate the SYNTAX score.

Results

pre-diabetic patients were older and had higher prevalence of hypertension than normoglycemic group (P value<0.001 and 0.001, respectively). Also, significant CAD (86 % vs. 74 %, P value = 0.034) and severe ischemic MR (16 % vs. 6 %, P value = 0.024) were more prevalent in pre-diabetic patients than in normoglycemic patients, whereas the absence of MR was more common in normoglycemic patients (21 % vs. 3 %, P value <0.001). The logistic regression analysis showed the association between significant CAD and pre-diabetes was independent of other variables (P value = 0.049, odds ratio [OR]: 2.402, 95 % CI: 1.005–5.741).

Conclusions

In our study, severe CAD and ischemic MR were more prevalent in pre-diabetic patients than normoglycemic ones that may be indicative of pre-diabetes as a high risk state in NSTE-ACS.