Abstract Introduction Coronary atherosclerosis is strongly related to certain comorbidities, such as diabetes, hyperlipidaemia, chronic kidney disease or hypertension. In addition, previous studies indicate a high prevalence of prediabetes in acute myocardial infarction. Treatment of atherosclerotic cardiovascular disease with SGLT-2 inhibitors and GLP-1 receptor antagonists improve cardiovascular and renal outcome thus are recommended for all T2DM patients with atherosclerotic vascular disease in the 2023 ESC guidelines. Purpose Our aim was to compare 3 consecutive months’ patients admitted to our clinic for acute coronary syndrome (ACS) with patients undergoing complex coronary plaque modification (rotational atherectomy, shockwave intravascular lithotripsy, orbital atherectomy) with respect to type 2 diabetes prevalence, HbA1c, LDL levels on admission as well as frequency of SGLT-2 inhibitors and GLP-1 RA therapy. Methods We performed a retrospective analysis of medical records of 213 patients admitted between 01.05.2024 and 31.07.2024 for acute coronary syndrome diagnosis to our department and compared it with 58 patients who underwent complex plaque modification in our institution between 01.2023 and 08.2024. Continuous variables were compared by t-test, discrete variables were compared by chi square test. Diabetes was defined as known and/or treated disease upon admission or a Hba1c of 6.5% or more, while prediabetes was diagnosed if DM was unknown and Hba1c was 5.7-6.4%. Results Prevalence of prediabetes was significantly higher in the acute coronary syndrome group, 35% vs 6.9% (p0.001), while T2DM was higher in the complex coronary intervention group (54% in the ACS, vs. 69% in the complex group, p0.05). Normal HBA1c was infrequent, 11% among acute coronary syndrome patients. One third of T2DM patients in the ACS group were newly diagnosed upon admission. Average HbA1c was 6.8±1.6% (5.2-15.3%) in ACS and 7.0±1.6 % in the complex intervention group (n.s). Average LDL was 2.87±1.18 mmol/L in the ACS versus 1.8±0.77 mmol/L (p0.001) in the complex intervention group, while chronic kidney disease did not differ accross the two groups (41 and 48%). ACS patients were somewhat younger (mean age: 67 vs 73.6 yrs), and fewer of ACS patient had known hypertension (78 vs 93%, p0.05), while the male to female ratio was similar between the 2 groups (68:32 and 71:29, respectively). Frequency of GLP1-RA therapy was found to be 13% in the complex group, 19% in the ACS group, while SGLT2- therapy was 48% in the complex and 58% in the ACS group (n.s). Conclusions Our data indicate that both prediabetes and T2DM is underdiagnosed in patients admitted for acute coronary syndrome. As a result, treatment with GLP1-RA and SGLT2I therapy is not applied as often as recommended by the 2023 ESC Guidelines.
Tímár et al. (Sat,) studied this question.