Gradient of Outcome Risk for Insulin-Treated vs. Non-Insulin Treated Diabetics Following Percutaneous Coronary Intervention

Blusztein, David

Gradient of Outcome Risk for Insulin-Treated vs. Non-Insulin Treated Diabetics Following Percutaneous Coronary Intervention

Monday, May 20, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

David Blusztein, M.B.B.S. , Royal Melbourne Hospital, Melbourne, Australia

Sinjini Biswas , Alfred Hospital, Melbourne, Australia

Nick Andrianopoulos , Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

Jeffrey Lefkovits , Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

Andrew Ajani , Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

Angela Brennan , Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

Stephen Duffy , Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

William Chan , The Alfred Hospital, Melbourne, Australia

David Clark , The Austin Hospital, Melbourne, Australia

Melanie Freeman , Eastern Health, Melbourne, Australia

Ernesto Oqueli , Ballarat Health Services, Melbourne, Australia

Christopher M Reid , Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

Dion Stub , Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

David Eccleston , Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

Matias Yudi , The Austin Hospital, Melbourne, Australia

Background:
Patients with diabetes mellitus have worse outcomes after percutaneous coronary intervention (PCI) than non-diabetics. It is uncertain however whether outcomes differ between insulin-treated (ITDM) and non-insulin treated (non-ITDM) diabetics.

Methods:
We prospectively enrolled 4,579 diabetic patients undergoing PCI between 2005 and 2014 in the Melbourne Interventional Group registry. Patient, procedural characteristics and 12-month outcomes were compared between ITDM and non-ITDM patients. Non-ITDM patients were further grouped into diet control or oral hypoglycaemic therapy (OHG) and their outcomes compared with ITDM patients.

Results:
Of the total group, ITDM comprised 3,468 (75.7%) and non-ITDM 1,111 patients (24.3%). ITDM patients were more likely to be male, obese, have peripheral vascular disease and receive drug-eluting stents (all p<0.001). On multivariable analysis, ITDM was an independent predictor of major adverse cardiovascular and cerebrovascular events (MACCE) 12 months post-PCI (OR 1.26, 95% CI 1.02–1.55, p=0.03).

Conclusions:
ITDM patients have higher rates of MACCE compared to non-ITDM patients 12 months post-PCI. There is a clear gradient of risk of adverse outcomes with escalation of therapy from diet control to OHG to insulin.