Faculty Bibliography

Background: Elevated periprocedural blood glucose is associated with increased mortality in percutaneous coronary intervention (PCI) patients regardless of diabetic status (Am Heart J 2003;146:351-358; Am J Cardiol 2005;96:543-546) and predicts renal and myocardial injury as well as target vessel revascularization in patients with diabetes mellitus (DM) undergoing PCI (Am J Cardiol 2004;94:1027-1029; JACC 2004;43:8-14). Strategies to safely achieve periprocedural glycemic control in the cardiac catheterization laboratory have not been systematically evaluated. Therefore, we performed an IRB approved pilot trial comparing the strategies of continuing versus holding prescribed long-acting hypoglycemic medications in patients with DM undergoing coronary angiography and possible PCI. Methods: Patients were randomly assigned to continue (n = 17) or hold (n = 18) their prescribed long-acting hypoglycemic medications. Patients scheduled for an afternoon procedure were encouraged to have a light morning snack. Blood glucose was assessed at the time of vascular access in the cardiac catheterization laboratory by nurses trained to use a glucometer. Hypoglycemia was defined as blood glucose <50 mg/ dL without symptoms or blood glucose <75 mg/dL with symptoms relieved by glucose supplementation. Data are expressed as mean + SD and significance assessed by t test. Results: Glucose was 137.8 + 57.4 in the continue medication group and 160.1 + 69.6 in the hold medication group (p = 0.3). There was 1 asymptomatic hypoglycemic event in the continue medication group (glucose = 43) that was corrected with intravenous glucose supplementation and no hypoglycemic events in the hold hypoglycemic medication group. Conclusions: In a setting where blood glucose levels are closely monitored, a strategy of routinely continuing long-acting hypoglycemic medications prior to coronary angiography may help achieve euglycemia during coronary angiography and PCI and appears safe. A larger trial with clinically significant endpoints is warranted

OBJECTIVES: We evaluated the effect of metabolic syndrome (a risk factor for the development of coronary artery disease) on survival in patients with established coronary artery disease. METHODS: Survival was determined for 2886 patients with coronary artery disease diagnosed by cardiac catheterization performed between 1990 and 2005 at a Department of Veterans Affairs hospital. Variables obtained from the computerized medical record were evaluated in multivariate analysis by Cox regression. The analysis was performed for the entire population; separate analyses were performed for patient cohorts treated with percutaneous coronary intervention and medication (n=1274), coronary artery bypass grafting and medication (n=1096), or medication alone (n=516). RESULTS: Although age (odds ratio 0.948; P<0.000), left ventricular function (odds ratio 0.701; P<0.000), serum creatinine (odds ratio 0.841; P<0.000), and smoking (odds ratio 0.873; P=0.019) were all strong predictors of mortality. Metabolic syndrome had no independent effect irrespective of diabetic status. CONCLUSION: Metabolic syndrome does not impact survival patients with coronary artery disease treated by revascularization and/or medical therapy

Strict glycemic control improves outcomes in critically ill patients. We evaluated the hypothesis that strict glycemic control might be similarly beneficial after percutaneous coronary intervention. This study reports the correlation of periprocedural blood glucose with long-term survival in 1,746 patients who underwent percutaneous coronary intervention from 1990 to 2003 in a Department of Veterans Affairs hospital