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. 2022 Oct 6;14(1):145.
doi: 10.1186/s13098-022-00915-9.

Predictive worth of estimated glucose disposal rate: evaluation in patients with non-ST-segment elevation acute coronary syndrome and non-diabetic patients after percutaneous coronary intervention

Chi Liu  1 , Xiaoli Liu  1 , Xiaoteng Ma  1 , Yujing Cheng  1 , Yan Sun  1 , Dai Zhang  1 , Qi Zhao  2 , Yujie Zhou  3
Affiliations

Predictive worth of estimated glucose disposal rate: evaluation in patients with non-ST-segment elevation acute coronary syndrome and non-diabetic patients after percutaneous coronary intervention

Chi Liu et al. Diabetol Metab Syndr. .

Abstract

Background: Measurement of estimated glucose disposal rate (eGDR) has been demonstrated to be an indicator of insulin resistance (IR) and a risk sign for long-term outcomes in those with ischemic heart disease and type 2 diabetes mellitus (T2DM) having coronary artery bypass grafting (CABG). After elective percutaneous coronary intervention (PCI), the usefulness of eGDR for prognosis in those with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and non-diabetes is yet unknown.

Methods: 1510 NSTE-ACS patients with non-diabetes who underwent elective PCI in 2015 (Beijing Anzhen Hospital) were included in this study. Major adverse cardio-cerebral events (MACCEs), such as all-cause mortality, non-fatal myocardial infarction, non-fatal ischemic stroke, and also ischemia-driven revascularization, were the main outcome of follow-up. The average number of follow-up months was 41.84.

Results: After multivariate Cox regression tests with confounder adjustment, the occurrence of MACCE in the lower eGDR cluster was considerably higher than in the higher eGDR cluster, demonstrating that eGDR is an independent prognostic indicator of MACCEs. In particular, as continuous variate: hazard ratio (HR) of 1.337, 95% confidence interval (CI) of 1.201-1.488, P < 0.001. eGDR improves the predictive power of usual cardiovascular risk factors for the primary endpoint. Specifically, the results for the area under the receiver operating characteristic (ROC) curve, this is AUC, were: baseline model + eGDR 0.699 vs. baseline model 0.588; P for contrast < 0.001; continuous net reclassification improvement (continuous-NRI) = 0.089, P < 0.001; and integrated discrimination improvement (IDI) = 0.017, P < 0.001.

Conclusion: Low eGDR levels showed a strong correlation with poor NSTE-ACS prognosis for nondiabetic patients undergoing PCI.

Keywords: Estimated glucose disposal rate; Non-ST-segment elevation acute coronary syndrome; Non-diabetes; Percutaneous coronary intervention; Prognosis.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flow diagram for the enrollment of study population. NSTE-ACS Non-ST-segment elevation acute coronary syndrome, PCI Percutaneous coronary intervention, CABG Coronary artery bypass grafting, eGFR estimated glomerular filtration rate, eGDR estimated glucose disposal rate
Fig. 2
Fig. 2
Kaplan–Meier survival curves according to the median of eGDR. A Kaplan–Meier survival curve of MACCE; B Kaplan–Meier survival curve of all-cause death; C Kaplan–Meier survival curve of non-fatal MI; D Kaplan–Meier survival curve of non-fatal ischemic stroke; E Kaplan–Meier survival curve of ischemia-driven revascularization. eGDR estimated glucose disposal rate, MACCE major adverse cardio-cerebral events, MI myocardial infarction, PCI percutaneous coronary intervention
Fig. 3
Fig. 3
Restricted cubic smoothing for the risk of MACCE according to the eGDR. The analysis was adjusted for Model 4. HR was evaluated by per 1-unit increase of eGDR. eGDR estimated glucose disposal rate, MACCE major adverse cardio-cerebral events, CI confidence interval
Fig. 4
Fig. 4
Subgroup analysis evaluating the robustness of eGDR in predicting the risk of the MACCE. The analysis was adjusted for Model 4 except for variates applied for grouping. HR was evaluated by per 1-unit decrease of eGDR. eGDR estimated glucose disposal rate, MACCE major adverse cardio-cerebral events, HR hazard ratio, CI confidence interval, BMI body mass index, CAD coronary artery disease, UA unstable angina, NSTEMI non-ST-segment elevation myocardial infarction, ACEI angiotensin-converting enzyme inhibitor, ARB angiotensin receptor blocker
Fig. 5
Fig. 5
ROC curve to assess the predictive value of eGDR for MACCE. The baseline risk model includes age, sex, BMI, previous MI, previous PCI, previous stroke, hyperlipidemia, smoking history, family history of CAD, eGFR, LVEF, SYNTAX score, complete revascularization. ROC receiver-operating characteristic, eGFR estimated glomerular filtration rate, MACCE major adverse cardio-cerebral events, AUC area under curve
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