Complete Revascularization in ACS Patients Related to Cardiorespiratory Fitness

Chang-Wook Nam, MD

A new investigation from the Republic of Korea suggested complete revascularization at the index in patients with non-diabetes mellitus multi-vessel acute coronary syndrome (ACS) was related with superior cardiorespiratory fitness.

The study was presented this week at the 19th Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease Meeting.

Investigators led by Chang-Wook Nam, MD, Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, noted that the implications of diabetes mellitus and revascularization status on cardiorespiratory fitness in multi-vessel ACS had not been well established prior to the study.

As such, Wan and colleagues elucidated on the implications during a 4-year study period.

The Methods

The study was conducted from December 2016 and December 2020.

At that time, all eligible ACS patients had undergone percutaneous coronary interventions (PCI) with stent implantation and also completed a cardiopulmonary exercise test (CPET).

A total of 82 patients with ACS were enrolled in the study, with the median age being 59.7±8.5 years old. A minority of patients were women (17.1%).

After all eligible patients were enrolled, they were then divided into either a diabetes mellitus group or a non-diabetes mellitus group. A total of 21 patients were in the former group, while 61 patients were in the latter group.

After being divided into the 2 groups, patients were further analyzed according to the revascularization status. Patients were either defined by complete revascularization (CR) or incomplete complete revascularization.

Investigators then established the primary endpoint as cardiorespiratory fitness defined by peak oxygen uptake at 1-year of the cardiopulmonary exercise test.

The secondary endpoints were defined as major adverse cardiac events such as a composite of cardiac death, MI, repeat coronary revascularization.

The Findings

In overall population, Wan and investigators reported that cardiorespiratory fitness was superior in patients with complete revascularization when compared to the patients with incomplete revascularization (25.9±3.7 vs. 22.8±4.0 ml/min/kg, p=0.029).

Additionally, the superior cardiorespiratory fitness by that was associated with achieving complete revascularization was consistent in non-diabetes mellitus patients (26.1 ± 4.2 vs. 23.7 ± 4.0 ml/min/kg, p=0.036).

However, Wan and colleagues noted that the positive effect of complete revascularization was blunted in diabetes mellitus patients (25.2 ± 2.3 vs. 24.0 ± 4.4 ml/min/kg, p=0.506).

Clinical outcomes were not significantly different between groups during a median follow-up of 703 days, with all events deemed “not significant” by investigators.

The investigators concluded that complete revascularization at the index procedure was related with superior cardiorespiratory fitness at 1-year in patients with non-diabetes mellitus multi-vessel ACS, adding that “Insulin resistance and microvascular dysfunction in DM patients blunted positive effect of CR”.

“The Effect of Diabetes Mellitus and Revascularization Status on Cardiorespiratory Fitness in Multi-vessel Acute Coronary Syndrome Patients,” was published online by WCIRDC.