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
Background:
Previous studies reported greater risk of cardiovascular events after percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) than in non-DM. Advances in diabetes management and PCI over the past decade such as sodium-glucose co-transporter 2 inhibitors have shown reduction in the risk of cardiovascular events and may have improved outcomes in PCI patients with DM.
Methods:
We prospectively collected follow-up data on 20,393 patients in the Melbourne Interventional Group (MIG) Registry between 2005 and 2014. Patient, procedural characteristics and clinical outcomes were compared by DM vs non-DM status.
Results:
Patients receiving PCI with DM were more likely to be female, obese (BMI >30 kg/m
2), have left ventricular dysfunction and renal impairment (p <0.001). DM patients were more likely to receive drug-eluting stents and were less likely to receive bare-metal stents when compared to non-DM (p <0.001). There was a significant increased rate of death and major adverse cardiac and cerebrovascular events (MACCE) in all follow-up phases (in-hospital, 30-day and 12-month) in patients with DM (p <0.05). There was also a significantly increased rate of target vessel revascularisation (TVR) and myocardial infarction (MI) at 12-months in the DM group (p<0.001). There was no significant difference in stroke rates in-hospital (p =0.053) but at 12-months, DM patients had increased stroke rates (p =0.043).
| | DM (n=4984) | Non-DM (n=15409) | P |
| In-hospital Mortality (%) | 2.7 | 2.0 | 0.004 |
| In-hospital MACCE (%) | 4.1 | 3.4 | 0.046 |
| 12-month Mortality (%) | 5.5 | 3.5 | <0.001 |
| 12-month MACCE (%) | 14.8 | 10.5 | <0.001 |
| 12-month TVR (%) | 6.9 | 5.4 | <0.001 |
| 12-month MI (%) | 5.1 | 3.1 | <0.001 |
Conclusions:
Despite advances in drug and device therapy over the past decade, patients with DM continue to experience increased mortality and MACCE in-hospital and at 12 months post-PCI compared to non-DM, with higher TVR and MI rates.
