Impact of insulin treated and non‐insulin‐treated diabetes compared to patients without diabetes on 1‐year outcomes following contemporary PCI

Abstract

Objective: We compared 1-year outcomes in insulin-treated diabetes mellitus (ITDM) and non-ITDM patients compared to nondiabetic (DM) patients following contemporary percutaneous coronary intervention (PCI). Background: ITDM is associated with extensive atherosclerotic disease and worse cardiovascular prognosis compared to non-ITDM patients. Methods: We evaluated PCI patients at a large tertiary center from 2010 to 2016, grouped according to diabetes and treatment status at baseline. One-year major adverse cardiac events (MACE) were defined as a composite of death, myocardial infarction (MI), or target vessel revascularization. Outcomes were adjusted using multivariable Cox regression methods. Results: During the study period, 16,889 patients underwent PCI including 13.7% ITDM, 34.0% non-ITDM, and 52.3% non-DM patients. Patients with DM were younger, including more females and non-white patients, with higher body mass index and greater prevalence of prior revascularization and chronic kidney disease. Compared to others, ITDM patients more often presented with acute coronary syndrome, in-stent restenosis, or severe lesion calcification. There were no differences in discharge rates of dual antiplatelet therapy and statins, whereas beta-blockers were more commonly prescribed in DM patients. At 1-year, both ITDM and non-ITDM patients had greater risk of MACE compared with non-DM patients, and ITDM conferred greater adjusted risk than non

Impact of diabetes mellitus on the early-phase arterial healing after drug-eluting stent implantation

“…Since a smaller balloon size and lower inflation pressure would result in less injury to the vessel wall, the difficulty of achieving complete apposition to the vessel wall and inadequate strut embedment, the post-dilatation balloon size and post-dilatation balloon inflation pressure were negatively associated with uncoverage in this study. Although a previous article revealed that the negative prognostic effect of DM following contemporary PCI was heightened in the presence of insulin treatment [34], insulin therapy did not impact on the early-phase arterial healing in the current study. Instead, we observed that the use of sulfonylurea was an independent predictor of the minimum NIC of grade 0 in the DM patients.…”

Impact of diabetes on coronary physiology evaluated by quantitative flow ratio in patients who underwent percutaneous coronary intervention

“…Percutaneous coronary intervention (PCI) has been generally recognized as a standard therapy to treat anatomical stenosis of coronary arteries. Nevertheless, current studies hold mixed opinions on the influence of diabetes on the prognosis of PCI 4 , 5 , 6 , 7 , 8 , 9 . Therefore, the impact of diabetes on the prognosis of patients who have undergone PCI is in need of reassessment brought by new approaches.…”

“…Nevertheless, current studies hold mixed opinions on the influence of diabetes on the prognosis of PCI [4][5][6][7][8][9] . Therefore, the impact of diabetes on the prognosis of patients who have undergone PCI is in need of reassessment brought by new approaches.…”

Efficacy of Drug-Eluting Stents in Diabetic Patients Admitted with ST-Elevation Myocardial Infarctions Treated with Primary Percutaneous Coronary Intervention

“…This disadvantage was evident both in patients undergoing revascularisation procedures and those who were conservatively treated. A recent analysis of PCI patients from New York confirmed these findings in more actual data: At one year, diabetes was associated with a 2.1× elevation in adverse event rates (MACE) in insulin-treated DM (ITDM) and with a HR of 1.27 in non-ITDM after PCI [20]. In the GRACE multinational registry, diabetes proved to be an independent factor to predict in-hospital and 6-month mortality in patients with ACS.…”