In-hospital, short-term and long-term adverse clinical outcomes observed in patients with type 2 diabetes mellitus vs non-diabetes mellitus following percutaneous coronary intervention

Abstract

Background: Several studies have shown that patients with type 2 diabetes mellitus (T2DM) have worse clinical outcomes in comparison to patients without diabetes mellitus (DM) following Percutaneous Coronary Intervention (PCI). However, the adverse clinical outcomes were not similarly reported in all the studies. Therefore, in order to standardize this issue, a meta-analysis including 139,774 patients was carried out to compare the in-hospital, short-term (<1 year) and long-term (≥1 year) adverse clinical outcomes in patients with and without T2DM following PCI. Methods: Electronic databases including MEDLINE, EMBASE, and the Cochrane Library were searched for Randomized Controlled Trials (RCTs) and observational studies. The adverse clinical outcomes which were analyzed included mortality, myocardial infarction (MI), major adverse cardiac events (MACEs), stroke, bleeding, target vessel revascularization (TVR), target lesion revascularization (TLR), and stent thrombosis. Risk Ratios (RR) with 95% confidence intervals (CI) were used to express the pooled effect on discontinuous variables and the analysis was carried out by RevMan 5.3 software. Results: A total number of 139,774 participants were assessed. Results of this analysis showed that in-hospital mortality and MACEs were significantly higher in patients with T2DM (RR 2.57; 95% CI: 1.95–3.38; P = .00001) and (RR: 1.38; 95% CI: 1.10–1.73; P = .005) respectively. In addition, majority of the short and long-term adverse clinical outcomes were also significantly higher in the DM group as compared to the non-DM group. Stent thrombosis was significantly higher in the DM compared to the non-DM group during the short term follow-up period (RR 1.59; 95% CI: 1.16–2.18; P = .004). However, long-term stent thrombosis was similarly manifested. Conclusion: According to this meta-analysis including a total number of 139,774 patients, following PCI, those patients with T2DM suffered more in-hospital, short as well as long-term adverse outcomes as reported by most of the Randomized Controlled Trials and Observational studies, compared to those patients without diabetes mellitus.

One Year Outcomes After Percutaneous Coronary Intervention in Diabetics With Stable Ischemic Heart Disease: A Single-Center Comparative Study

“…Regarding the angiographic profile, double vessel disease was the common angiography pattern and LAD was the most commonly involved vessel in both groups, which is consistent with previous studies [ 8 , 11 ]. The current study shows that DM patients are more at risk of adverse clinical outcomes after PCI, either during the hospital stay or at a one-year follow-up, which is similar to the findings of Zhuo et al [ 12 ]. In our study, stent thrombosis and contrast-induced nephropathy have been found to be higher in DM patients during their hospital stay, but at one year follow-up MACE, followed by stent thrombosis, were more in the non-DM group, which is in line with previous studies [ 12 ].…”

“…This finding is in line with Mathew et al [ 16 ]. Similarly, a study by Zhuo et al [ 12 ] also demonstrated worse outcomes in DM patients on follow-up. Kedhi et al [ 17 ] also reported a high number of deaths, MI, and stent thrombosis in the DM group after PCI, thus supporting our findings.…”

Cost-Effectiveness of Alirocumab for the Secondary Prevention of Cardiovascular Events after Myocardial Infarction in the Chinese Setting

“…In the ODYSSEY OUTCOMES research, a more pronounced absolute risk reduction was observed in patients with polyvascular disease than monovascular disease (Jukema et al, 2019). As the traditional risk factors for adverse events, cost-effectiveness of alirocumab were calculated in pre-existing diabetes mellitus (DM) (Li et al, 2016;Zhuo et al, 2019) and hypertension population (Chen et al, 2009;De Luca et al, 2014) with MI, respectively. Other scenario analyses were also performed, including initiating treatment among patients in different ages, varying the duration of alirocumab use between 5 and 30 years and applying various discount rates to the model.…”

Effects of stent generation on clinical outcomes after acute myocardial infarction compared between prediabetes and diabetes patients

“…Coronary vessels in patients with diabetes usually present extensive atherosclerosis with a larger number of significant stenosis, longer lesions, and more diffuse disease 3 , 4 . Therefore, despite advances in interventional skill, devices, and antiplatelet agents, outcomes of coronary revascularization in patients with diabetes have been poorer than those without 5 , 6 . Percutaneous coronary intervention (PCI) in patients with diabetes is associated with increased incidence of restenosis, repeat revascularization, stent thrombosis (ST), and all-cause mortality than those without 3 , 4 .…”