Abstract 3209: Impaired Glucose Tolerance is Associated With Positive Coronary Artery Remodeling in Non-diabetic Patients with ST-elevation Acute Myocardial Infarction
Previous studies in non-diabetic subjects have shown that impaired glucose tolerance (IGT), rather than abnormal fasting glucose, is associated with a higher incidence of acute myocardial infarction (AMI). Positive remodeling of coronary artery is a compensatory response to atherosclerotic plaque accumulation and is associated with plaque instability. We hypothesized that IGT, pre-stage of diabetes, is associated with positive coronary artery remodeling in non-diabetic patients with AMI. Intravascular ultrasound interrogation of culprit vessel was performed before percutaneous coronary intervention in 113 non-diabetic patients (94 men) with ST-elevation AMI. All patients underwent a 75g oral glucose tolerance test before discharge. Remodeling was defined as positive when external elastic membrane area (EEM) at the lesion site was greater than EEM for proximal and distal reference sites. Remodeling index was defined as lesion EEM divided by proximal EEM. Patients with IGT (n=75, 70%) had higher body mass index (25.1 vs 23.0 kg/m2, p=0.003), higher triglyceride levels (126 vs 90 mg/dL, p=0.015), and lower high-density lipoprotein cholesterol levels (45 vs 50 mg/dL, p=0.026) than those with normal glucose tolerance (NGT). The incidence of positive remodeling (61 vs 24 %, p<0.001) and remodeling index (1.16 vs 1.05, p=0.018) were higher in patients with IGT than those with NGT. Multiple logistic regression analysis including age, sex, and coronary risk factors demonstrated that IGT is an independent determinant of positive remodeling (odds ratio;6.2, p=0.001). Moreover, patients with positive remodeling (n=55) had higher levels of the glucose area under the concentration-time curve value than those without (21587 vs 19587 mg/dL per 2 hours, p=0.006), whereas fasting glucose levels did not differ between patients with and without positive remodeling (105 vs 103 mg/dL, p=0.171). IGT is associated with positive coronary artery remodeling in non-diabetic patients with AMI, which may lead to acute presentation of coronary artery disease. Lifestyle modification and aggressive pharmacological intervention to ameliorate IGT may reduce cardiovascular events in IGT subjects even before overt diabetes.