Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

Abstract

ObjectivesTo assess the mortality in patients with diabetes mellitus (DM) following percutaneous coronary intervention (PCI) according to their insulin requirement and PCI setting (elective, urgent, and emergency).BackgroundDM is a major risk factor to develop coronary artery disease (CAD). It is unclear if meticulous glycemic control and aggressive risk factor management in patients with DM has improved outcomes following PCI.MethodsRetrospective analysis of prospectively collected data on 9,224 patients treated with PCI at a regional tertiary center between 2008 and 2011.ResultsAbout 7,652 patients were nondiabetics (non‐DM), 1,116 had non‐insulin treated diabetes mellitus (NITDM) and 456 had ITDM. Multi‐vessel coronary artery disease, renal impairment and non‐coronary vascular disease were more prevalent in DM patients. Overall 30‐day mortality rate was 2.4%. In a logistic regression model, the adjusted odds ratios (95% confidence intervals [CI]) for 30‐day mortality were 1.28 (0.81–2.03, P = 0.34) in NITDM and 2.82 (1.61–4.94, P < 0.001) in ITDM compared with non‐DM. During a median follow‐up period of 641 days, longer‐term post‐30 day mortality rate was 5.3%. In the Cox's proportional hazard model, the hazard ratios (95% CI) for longer‐term mortality were 1.15 (0.88–1.49, P = 0.31) in NITDM and 1.88 (1.38–2.55, P < 0.001) in ITDM compared with non‐DM group. Similar result was observed in all three different PCI settings.ConclusionIn the modern era of aggressive cardiovascular risk factor control in diabetes, this study reveals higher mortality only in insulin‐treated diabetic patients following PCI for stable coronary artery disease and acute coronary syndrome. Importantly, diabetic patients with good risk factor control and managed on diet or oral hypoglycemics have similar outcomes to the non‐diabetic population. © 2016 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

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

“…34 All DM patients should be carefully monitored during follow-up for adherence as well as optimal control of HbA1c levels and reduction in obesity levels. [8][9][10][11] In addition to high intensity statins, novel drugs inhibiting PCSK9 and CRP lowering anti-inflammatory agents may have a role in mitigating risk among ITDM patients. 24,35,36 Ongoing management of ITDM patients post-PCI requires close multidisciplinary collaboration between cardiologists and other specialty teams.…”

“…[2][3][4][5][6] Nonstent related ischemic outcomes are also significantly worse, 7 and as such, risk factor management and optimizing glycemic control remain paramount. [8][9][10][11] Insulin-treated DM (ITDM) has been shown to be associated with particularly high risk of events, and these patients are usually commenced on insulin in later stages of DM, resulting in greater prevalence of associated comorbidities, including chronic kidney disease (CKD) and anemia. 12 Indeed, recent data have shown that ITDM patients have a greater risk of adverse outcomes with an increase in all-cause and cardiovascular mortality 1-year after percutaneous coronary intervention (PCI).…”

“…12 Indeed, recent data have shown that ITDM patients have a greater risk of adverse outcomes with an increase in all-cause and cardiovascular mortality 1-year after percutaneous coronary intervention (PCI). 7,8 We sought to describe the patient and procedural characteristics, as well as report 1-year clinical outcomes in ITDM compared to non-ITDM and non-DM patients following contemporary PCI from a high volume complex PCI center treating a wide socioeconomic mix of coronary artery disease patients.…”

Clinical Characteristics and Outcomes of COVID-19 Positive Acute Coronary Syndrome Patients; a multisource Electronic Healthcare Records Study from England

“…This study was conducted under the endorsement of the Chief Scientific Advisor to the UK government and Scientific Advisory Group for Emergencies (SAGE) [13][14][15][16] . The study complies with the Declaration of Helsinki.…”

The impact of diabetes on the prognostic value of left ventricular function following percutaneous coronary intervention: Insights from the British Cardiovascular Intervention Society

“…We did not have longer‐term outcome data available, although this would be of interest in a future study. Whilst it is well known that effective management of DM is associated with improved patient outcomes, the BCIS dataset does not collect data on either hypoglycemic agents or glycemic control . We were not able to account for the potentially important effect of undiagnosed/untreated diabetes.…”