The Association between Type-2 Diabetes Duration and Major Adverse Cardiac Events after Percutaneous Coronary Intervention

Abstract

Background. Diabetes is an independent risk factor for coronary artery disease and portends adverse prognosis in diabetic patients undergoing percutaneous coronary intervention (PCI) compared to nondiabetic patients. Few studies are currently available regarding the relationship between diabetes duration and major adverse cardiac events (MACEs) post-PCI. This study is aimed at assessing the association between diabetes duration and major adverse cardiac events after PCI. Methods. A total of 302 cases of diabetic patients undergoing an elective PCI with drug-eluting stent (DES) deployment and or percutaneous transluminal coronary angioplasty (PTCA) using a drug-coated balloon (DCB) were prospectively studied. We divided patients into three groups based on diabetes duration: <5 years group ( n = 165 ), 5–10 years’ group ( n = 72 ), and ≥10 years’ group ( n = 65 ). Angiographic and clinical follow-up were conducted 12 months after the procedures for all the patients and at any given time during the study when needed. Results. A significantly higher rate of myocardial infarction (MI) in diabetic patients with the longest diabetes duration (7.7% vs. 0% and 0.6%, P = 0.001 ) was observed compared with groups of shorter duration. Repeat coronary revascularization was found to be significantly higher in the >10-year group than was it in groups with shorter duration of diabetes (23.1% vs. 19.4% and 9.10%, P = 0.03 ). After adjustment for confounding risk factors, longer diabetes duration remained an independent predictor of MI (hazard ratio (HR): 5.525, confidence interval (CI): 1.273-23.978, P = 0.022 ) and repeat revascularization (HR: 1.608, CI: 1.058-2.443, P = 0.026 ). Repeat revascularization was significantly related to the progression of nontreated lesions (De novo lesions 20% vs. 18% and 7.3%, P = 0.009 ) compared to previously treated lesions (target lesion revascularization (TLR) 3% vs. 1.3% and 2%, P = 0.774 ). However, all-cause mortality was not significantly different among the groups (3.1% vs. 5.6% and 0.6%, P = 0.06 , HR: 2.403, CI: 0.464-12.436, P = 0.293 ). Conclusion. Diabetes duration was associated with significant differences in major adverse cardiac events after the percutaneous coronary intervention; the longest diabetes duration portended higher rates of MACEs than shorter duration at the 12-month follow-up.

Drug-Coated Balloon-Only Angioplasty Outcomes in Diabetic and Nondiabetic Patients with De Novo Small Coronary Vessels Disease

“…Diabetes remained an independent predictor for TLF (HR: 2.712; CI: 1.254–5.864; P =0.011) and TLR (HR: 3.698; CI: 1.112–12.298; P =0.033) after adjustment. Our findings are in keeping with the previous studies that reported acceptable low rates of TLF and MACE with DCB in the small vessel [ 11 , 21 , 29 , 31 – 37 ]. The PEPCAD I study reported 6.1% MACE events' rates after 12-month follow-up; the BASKET-SMALL 2 trial observed 7.5% MACE rates in the DCB arm [ 23 , 31 ].…”

“…Besides, there is an established association between small vessel coronary disease with diabetes mellitus, which is also a powerful predictor for poor outcomes after PCI [1,[14][15][16][17][18][19][20]. Conceived to overcome the drawbacks observed with DES, emerging evidence suggests using drug-coating balloons (DCB) as an interesting alternative treatment strategy in small vessel disease [21][22][23][24][25]. Because of the higher prevalence of SVD observed in diabetic patients, this group of patients is more likely to be treated with the drug-coated balloon.…”

Multi-vessel Coronary Artery Disease in Diabetic Patients Presenting with Anterior Wall Myocardial Infraction

“…Such factors included duration of DM, 13 the longer duration of type II DM is not only a significant risk factor for the development of multi-vessel disease, but it has been reported to be a significant independent predictor of 1-year major adverse cardiovascular events rate after percutaneous coronary intervention. 14 Addition to the duration of DM, poor glycemic control is another important clinical determinant found to be strongly associated with a higher risk of MVD, as observed by Pathak SR et al 13 72.2% vs. 10% multi-vessel diseases among patients with poor (HbA1c > 8.5%) and good glycemic control (HbA1c < 7.0%), respectively. Older age is the most commonly reported factor among other clinical predictors of multi-vessel disease.…”

Factors associated with disease severity of COVID‑19 in patients with type 2 diabetes mellitus

“…Chronic complications were noted in only 20.9% of the patients in the present study, most likely due to the facts that diabetes mellitus onset for the majority was <10 years and most patients were aged <60 years. The longer a patient has T2DM, the more vascular complications there are, particularly cardiovascular complications ( 38 ). A study performed in Israel on 5,869 COVID-19 individuals with T2DM revealed that for the majority of patients T2DM onset was >10 years ( 22 ).…”