Differential Impact of Type 1 and Type 2 Diabetes Mellitus on Outcomes Among 1.4 Million US Patients Undergoing Percutaneous Coronary Intervention

Matetić, Andrija; Doolub, Gemina; Bharadwaj, Aditya; Biondi‐Zoccai, Giuseppe; Ullah, Waqas; Bagur, Rodrigo; Velagapudi, Poonam; Alraies, M. Chadi; Mohamed, Mohamed

doi:10.1016/j.carrev.2021.08.018

Cited by 5 publications

(3 citation statements)

References 30 publications

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“…Our previous study demonstrated that patients with type 1 diabetes have higher short-term (30-day and 1-year) case fatality rates after MI compared to patients without diabetes while sharing otherwise similar baseline features [12]. Patients with type 1 diabetes undergoing PCI seemed to be at a particularly high risk of adverse inhospital outcomes including MACE, mortality, and major bleeding [17]. The present study extended these findings by showing that long-term (median follow-up 3.9 years) cardiovascular prognosis after MI in patients with type 1 diabetes compared to non-diabetic controls was substantially poorer.…”

Section: Main Findings In Relation To Previous Literaturementioning

confidence: 99%

Long-term cardiovascular prognosis of patients with type 1 diabetes after myocardial infarction

Kerola

Semb

Juonala

et al. 2022

Cardiovasc Diabetol

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Background To explore long-term cardiovascular prognosis after myocardial infarction (MI) among patients with type 1 diabetes. Methods Patients with type 1 diabetes surviving 90 days after MI (n = 1508; 60% male, mean age = 62.1 years) or without any type of diabetes (n = 62,785) in Finland during 2005–2018 were retrospectively studied using multiple national registries. The primary outcome of interest was a combined major adverse cardiovascular event (MACE; cardiovascular death, recurrent MI, ischemic stroke, or heart failure hospitalization) studied with a competing risk Fine-Gray analyses. Median follow-up was 3.9 years (maximum 12 years). Differences between groups were balanced by multivariable adjustments and propensity score matching (n = 1401 patient pairs). Results Cumulative incidence of MACE after MI was higher in patients with type 1 diabetes (67.6%) compared to propensity score-matched patients without diabetes (46.0%) (sub-distribution hazard ratio [sHR]: 1.94; 95% confidence interval [CI]: 1.74–2.17; p < 0.0001). Probabilities of cardiovascular death (sHR 1.81; p < 0.0001), recurrent MI (sHR 1.91; p < 0.0001), ischemic stroke (sHR 1.50; p = 0.0003), and heart failure hospitalization (sHR 1.98; p < 0.0001) were higher in patients with type 1 diabetes. Incidence of MACE was higher in diabetes patients than in controls in subgroups of men and women, patients aged < 60 and ≥ 60 years, revascularized and non-revascularized patients, and patients with and without atrial fibrillation, heart failure, or malignancy. Conclusions Patients with type 1 diabetes have notably poorer long-term cardiovascular prognosis after an MI compared to patients without diabetes. These results underline the importance of effective secondary prevention after MI in patients with type 1 diabetes.

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Section: Main Findings In Relation To Previous Literaturementioning

confidence: 99%

Long-term cardiovascular prognosis of patients with type 1 diabetes after myocardial infarction

Kerola

Semb

Juonala

et al. 2022

Cardiovasc Diabetol

View full text Add to dashboard Cite

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“…Moreover, insulin-treated compared with non–insulin-treated patients with type 2 diabetes tend to fare worse with regard to both short- and long-term outcomes after PCI ( 34 ), as well as in the settings of STEMI and primary PCI ( 35 ). According to a recent U.S.-based observational study from 2015 to 2018, patients with type 1 diabetes were at particularly high risk for adverse in-hospital outcomes after PCI compared with patients with type 2 diabetes and individuals without diabetes ( 36 ). In addition to revascularization status, higher age, presence of ST elevation, and many prior comorbidities (e.g., liver or renal disease, peripheral vascular disease, alcohol abuse, and heart failure) were predictors of higher case fatality after MI in the type 1 diabetes cohort of our study.…”

Section: Discussionmentioning

confidence: 99%

Case Fatality of Patients With Type 1 Diabetes After Myocardial Infarction

et al. 2022

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OBJECTIVE Type 1 diabetes is a risk factor for myocardial infarction (MI). We aimed to evaluate the case fatality in patients with type 1 diabetes after MI. RESEARCH DESIGN AND METHODS Consecutive patients experiencing MI with type 1 diabetes (n = 1,935; 41% female; mean age 62.5 years) and without diabetes (n = 74,671) admitted to 20 hospitals in Finland from 2005 to 2018 were studied using national registries. The outcome of interest was death within 1 year after MI. Differences between groups were balanced by multivariable adjustments and propensity score matching. RESULTS Case fatality was higher in patients with type 1 diabetes than in propensity score–matched controls without diabetes at 30 days (12.8% vs. 8.5%) and at 1 year (24.3% vs. 16.8%) after MI (hazard ratio 1.55; 95% CI 1.32–1.81; P < 0.0001). Patients with type 1 diabetes had poorer prognosis in subgroups of men and women and of those with and without ST-elevation MI, with and without revascularization, with and without atrial fibrillation, and with and without heart failure. The relative fatality risk in type 1 diabetes was highest in younger patients. Older age, heart failure, peripheral vascular disease, renal failure, and no revascularization were associated with worse prognosis after MI. The case fatality among patients with type 1 diabetes decreased during the study period, but outcome differences compared with patients without diabetes remained similar. CONCLUSIONS Patients with type 1 diabetes are at higher risk of death after MI than patients without diabetes. Our findings call for attention to vigorous cardiovascular disease prevention in patients with type 1 diabetes.

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“…This elevated risk is higher in patients with type 1 DM; this might reflect a longer duration of diabetes and different pathogenetic mechanisms, including autoimmune pathways [58]. However, the incidence of type 1 DM is hugely lower in patients with cardiovascular diseases undergoing PCI and in the general population compared with type 2 DM [59]. This explains why most data on diabetes impact in PCI cohorts regards to type 2 DM.…”

Section: Abnormal Glucose Levels and Pci Complicationsmentioning

confidence: 99%

Glycaemic Control in Patients Undergoing Percutaneous Coronary Intervention: What Is the Role for the Novel Antidiabetic Agents? A Comprehensive Review of Basic Science and Clinical Data

Nusca

Piccirillo

Bernardini

et al. 2022

IJMS

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Coronary artery disease (CAD) remains one of the most important causes of morbidity and mortality worldwide, and revascularization through percutaneous coronary interventions (PCI) significantly improves survival. In this setting, poor glycaemic control, regardless of diabetes, has been associated with increased incidence of peri-procedural and long-term complications and worse prognosis. Novel antidiabetic agents have represented a paradigm shift in managing patients with diabetes and cardiovascular diseases. However, limited data are reported so far in patients undergoing coronary stenting. This review intends to provide an overview of the biological mechanisms underlying hyperglycaemia-induced vascular damage and the contrasting actions of new antidiabetic drugs. We summarize existing evidence on the effects of these drugs in the setting of PCI, addressing pre-clinical and clinical studies and drug-drug interactions with antiplatelet agents, thus highlighting new opportunities for optimal long-term management of these patients.

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Differential Impact of Type 1 and Type 2 Diabetes Mellitus on Outcomes Among 1.4 Million US Patients Undergoing Percutaneous Coronary Intervention

Cited by 5 publications

References 30 publications

Long-term cardiovascular prognosis of patients with type 1 diabetes after myocardial infarction

Long-term cardiovascular prognosis of patients with type 1 diabetes after myocardial infarction

Case Fatality of Patients With Type 1 Diabetes After Myocardial Infarction

Glycaemic Control in Patients Undergoing Percutaneous Coronary Intervention: What Is the Role for the Novel Antidiabetic Agents? A Comprehensive Review of Basic Science and Clinical Data

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