Prediabetes: An overlooked risk factor for major adverse cardiac and cerebrovascular events in atrial fibrillation patients

BACKGROUND Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events(MACCE).However,the relationship between prediabetes and MACCE in atrial fibrillation(AF)patients has not been extensively studied.Therefore,this study aimed to establish a link between prediabetes and MACCE in AF patients.AIM To investigate a link between prediabetes and MACCE in AF patients.METHODS We used the National Inpatient Sample(2019)and relevant ICD-10 CM codes to identify hospitalizations with AF and categorized them into groups with and without prediabetes,excluding diabetics.The primary outcome was MACCE(all-cause inpatient mortality,cardiac arrest including ventricular fibrillation,and stroke)in AF-related hospitalizations.RESULTS Of the 2965875 AF-related hospitalizations for MACCE,47505(1.6%)were among patients with prediabetes.The prediabetes cohort was relatively younger(median 75 vs 78 years),and often consisted of males(56.3%vs 51.4%),blacks(9.8%vs 7.9%),Hispanics(7.3%vs 4.3%),and Asians(4.7%vs 1.6%)than the non-prediabetic cohort(P<0.001).The prediabetes group had significantly higher rates of hypertension,hyperlipidemia,smoking,obesity,drug abuse,prior myocardial infarction,peripheral vascular disease,and hyperthyroidism(all P<0.05).The prediabetes cohort was often discharged routinely(51.1%vs 41.1%),but more frequently required home health care(23.6%vs 21.0%)and had higher costs.After adjusting for baseline characteristics or comorbidities,the prediabetes cohort with AF admissions showed a higher rate and significantly higher odds of MACCE compared to the non-prediabetic cohort[18.6%vs 14.7%,odds ratio(OR)1.34,95%confidence interval 1.26-1.42,P<0.001].On subgroup analyses,males had a stronger association(aOR 1.43)compared to females(aOR 1.22),whereas on the race-wise comparison,Hispanics(aOR 1.43)and Asians(aOR 1.36)had a stronger association with MACCE with prediabetes vs whites(aOR 1.33)and blacks(aOR 1.21).CONCLUSION This population-based study found a significant association between prediabetes and MACCE in AF patients.Therefore,there is a need for further research to actively screen and manage prediabetes in AF to prevent MACCE.

Incidence of Major Adverse Cardiovascular and Cerebrovascular Events in Chinese Patients Undergoing Percutaneous Coronary Intervention with Iodixanol: An Observational Postauthorization Study

Objective:This study aimed to evaluate the major adverse cardiovascular and cerebrovascular events(MACCEs)and overall safety profile associated with iodixanol in Chinese patients undergoing percutaneous coronary intervention(PCI).Methods:Patients at 30 centers in China registered in the OpenClinic v3.6 database from October 30,2013,to October 7,2015,were included in the study.The primary endpoint was in-hospital MACCEs including target lesion revascularization(TLR),stroke,stent thrombosis,cardiac death,and PCI-related myocardial infarction(MI)within 72 h post-PCI.Secondary endpoints were MACCEs from 72 h to 30 d post-PCI and other safety events within 30 d post-PCI.Results:A total of 3,042 patients were enrolled.The incidence of MACCEs within 72 h post-PCI was 2.33%(n=71),including cardiac death(0.03%,n=1)and PCI-related MI(2.30%,n=70).The incidence of MACCEs from 72 h to 30 d post-PCI was 0.16%(n=5),including cardiac death(0.10%,n=3),PCI-related MI(0.03%,n=1),and TLR for stent thrombosis(0.03%,n=1).The incidence of composite angiographic or procedural complications was 2.86%(n=87);233(7.86%)patients had results suggesting contrast-induced acute kidney injury.Conclusions:These findings indicate that the use of iodixanol in Chinese patients undergoing PCI is associated with a low incidence of MACCEs,confirming its safety in this population.