Correlation Study On The Degree Of Coronary Artery Disease And Its Prognosis In Patients With Pre-diabetic Coronary Heart Disease

Background Diabetes is an independent risk factor for coronary heart disease,and its clinical studies have been widely verified,and the range of blood glucose control is directly related to the degree of coronary artery disease.The burden of diabetes(Type 2Diabetes,T2DM)is expected to rise from 415 million people in 2015 to 642 million people in 2040.However,most people go through a pre-diabetes stage before they develop complete diabetes.Studies have shown that there is a clear connection between coronary heart disease(CHD)and pre-diabetes.Diabetes,pre-diabetic hyperglycemia and insulin resistance lead to an increase in reactive oxygen species,which triggers intracellular molecular signal transduction,leading to an increase in prethrombotic state and inflammatory mediators,accelerating endothelial function changes and macrovascular complications.Objective In pre-diabetic patients,assess the relationship between glycosylated hemoglobin(Hb A1c)and fasting blood glucose(FBG)and the severity of coronary artery disease in patients with coronary artery disease diagnosed by coronary angiography(CAG).The combination of SYNTAX score and GENSINI scoring system was used to evaluate the severity of coronary heart disease,and the difference between the two groups of adverse events was compared at the same time,which provided reasonable guidance for blood glucose control in patients with pre-diabetic coronary heart disease.Methods1.Research subjects: This study selected patients who underwent coronary angiography and diagnosed coronary atherosclerotic heart disease at the Huazhong Cardiovascular Hospital of Fuwai from July 1,2018 to December 30,2018.Inclusion criteria: 1.Age 18-80 years;2.According to the naming and diagnostic criteria of ischemic heart disease in the "Nomenclature and Diagnostic Criteria for Ischemic Heart Disease" published by the International Association of Cardiology and WHO,coronary artery disease Atherosclerotic heart disease is diagnosed by coronary angiography(Coronary,angiography,CAG);3.Patients with complete medical records.Exclusion criteria: 1.Patients with a clear diagnosis of diabetes or taking hypoglycemic drugs;2.Chronic heart failure(CHF),cardiac insufficiency,chronic obstructive pulmonary disease(COPD);3.Fasting Blood glucose level <3.9mmol/L;4.Past type I diabetes,severe liver and kidney disease,infectious disease,autoimmune disease and tumor.5.Pregnancy;6.Incomplete medical records or repeated hospitalizations of the same patient.2.Grouping basis: Among patients with coronary heart disease diagnosed by coronary angiography(CAG),patients with coronary heart disease with a glycosylated hemoglobin value of 5.7%-6.4% were screened,and they were divided into three groups A and B according to the fasting blood glucose measured on admission.Group A The fasting blood glucose group is normal,that is,the fasting blood glucose value is less than 6.0 mmol/L(n=108);the B group is the fasting blood glucose impaired group,that is,the fasting blood glucose value is 6.0-7.0 mmol/L(n=70).3.Research method: The general information of the patient includes: gender,age,weight,medical history of hypertension,history of hyperlipidemia,smoking history,etc.,FBG,blood routine,glycosylated hemoglobin(glycosylated,hemoglobin,Hb A1c)in the fasting venous blood in the morning more than 8 hours after admission),cholesterol and other national triglycerides,high-density lipoprotein,low-density lipoprotein,and cardiac ultrasound examination results.The SYNTAX and GENSINI scores are calculated based on the patient’s coronary angiography results.According to the scoring results,the patients were divided into three groups:low,medium,and high,and the differences in clinical indicators were compared.Simple linear regression and multiple linear regression were used to correct for confounding factors,analyze the correlation between each influencing factor and the SYNTAX and GENSINI scores,and analyze the risk factors of coronary heart disease in patients with high SYNTAX scores and high GENSINI scores.All patients were followed up for 1 year after discharge to observe the incidence of cardiovascular adverse events,including acute myocardial infarction,severe heart failure,cardiogenic death and other adverse events.Results1.There was no significant difference in gender,age,smoking history,history of hypertension,LVEF,TC,TG,and LDL-C levels between the two groups of patients(P>0.05);BMI,glycosylated hemoglobin,and fasting blood glucose levels of the two groups In comparison,the difference was statistically significant(P<0.05).2.Among the 5.7%-6.4% patients with glycosylated hemoglobin,the two groups with different levels of fasting blood glucose were related to the degree of coronary artery disease(P<0.05).3.After linear regression analysis,it was found that gender,age,smoking history,fasting blood glucose,Hb1 AC,HDL-C,and BMI may all have an impact on the SYNTAX score.The stepwise regression method of multiple linear regression model was further used to incorporate the above factors into multiple linear regression.After adjusting for confounding factors,it was found that age,gender,LDL-C and SYNTAX score were independently correlated;after the same GNSINI score correlation analysis,it was found that gender,age,BMI,fasting blood glucose,and Hb1 AC can significantly affect the GENSINI score.4.Among the adverse events during the outpatient follow-up,11 adverse events occurred in patients in the impaired fasting blood glucose group,and 5 adverse events occurred in patients in the normal fasting blood glucose group.Comparing the incidence of adverse events between the two groups,the difference was statistically significant(P<0.05).Conclusions This study shows that in patients with coronary heart disease diagnosed by coronary angiography with prediabetes,fasting blood glucose and glycosylated hemoglobin are both related to GENSINI score and SYNTAX score.After regression analysis,fasting blood glucose and glycosylated hemoglobin are independent risk factors for the burden of coronary atherosclerosis.Among patients with glycosylated hemoglobin 5.7%-6.4%,patients with abnormal fasting blood glucose had a higher incidence of adverse prognostic events.