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Title: Comparison of Long-Term Outcomes After Percutaneous Coronary Intervention in Patients With Insulin-Treated vs. Non-Insulin Treated Diabetes Mellitus.
Austin Authors: Biswas, Sinjini;Dinh, Diem;Andrianopoulos, Nick;Lefkovits, Jeffrey;Ajani, Andrew;Duffy, Stephen J;Chan, William;Walton, Antony;Brennan, Angela;Clark, David J ;Hiew, Chin;Oqueli, Ernesto;Reid, Christopher M;Stub, Dion;Eccleston, David
Affiliation: Department of Medicine, University of Melbourne, Melbourne, Australia
School of Medicine, Deakin University, Ballarat, Australia
School of Public Health, Curtin University, Perth, Australia
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Department of Cardiology, University Hospital Geelong, Geelong, Australia
Department of Cardiology, The Alfred Hospital, Melbourne, Australia
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Department of Medicine, University of Melbourne, Melbourne, Australia
Baker Heart and Diabetes Institute, Melbourne, Australia
Department of Cardiology, Ballarat Health Services, Ballarat, Australia
Issue Date: 2-Mar-2021
Date: 2021-03-02
Publication information: The American Journal of Cardiology 2021; online frist: 2 March
Abstract: There are conflicting data on whether patients with insulin-treated diabetes mellitus (ITDM) have poorer outcomes compared to non-insulin treated diabetic (non-ITDM) patients following percutaneous coronary intervention (PCI). We therefore compared clinical outcomes following PCI in ITDM versus non-ITDM patients. We prospectively collected data on 4,579 patients with diabetes undergoing PCI between 2005 and 2014 in a large multi-centre registry and dichotomised them as having ITDM (n=1,111) or non-ITDM (n=3,468). The non-ITDM group was further divided into diet control only (diet-DM; n=786) and those taking oral hypoglycaemic agents (OHG-DM; n=2,639), and clinical outcomes were compared with ITDM patients. Median follow-up for long-term mortality was 4.2 years (IQR 2.0-6.6 years). ITDM patients were more likely to be female, obese, and have severe renal impairment (all p<0.001). Procedural characteristics were similar other than a greater use of drug-eluting stents in ITDM patients. On multivariable analysis, ITDM was an independent predictor of 12-month major adverse cardiovascular and cerebrovascular events (MACCE; OR 1.26, 95% CI 1.02-1.55, p=0.03). Dividing the non-ITDM group further by treatment, a progressively higher rate of 12-month MACCE across the 3 groups was observed (13.5% vs. 17.9% vs. 21.8%; p<0.001). Long-term mortality was similar in the diet-DM and OHG-DM groups, but significantly higher in the ITDM group on Kaplan-Meier analysis (log-rank p<0.001). In conclusion, there is a clear gradient of adverse outcomes with escalation of therapy from diet control to OHGs to insulin.
DOI: 10.1016/j.amjcard.2021.02.025
Journal: The American Journal of Cardiology
PubMed URL: 33667454
Type: Journal Article
Subjects: diabetes mellitus
percutaneous coronary intervention
Appears in Collections:Journal articles

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