Outcomes in Patients with Diabetes Mellitus According to Insulin Treatment After Percutaneous Coronary Intervention in the Second-Generation Drug-Eluting Stent Era

医学 经皮冠状动脉介入治疗 传统PCI 内科学 心脏病学 危险系数 心肌梗塞 糖尿病 人口 血运重建 置信区间 环境卫生 内分泌学
作者
Seung-Hoon Pi,Tae‐Min Rhee,Joo Myung Lee,Doyeon Hwang,Jonghanne Park,Taek Kyu Park,Jeong Hoon Yang,Young Bin Song,Jin‐Ho Choi,Joo‐Yong Hahn,Byung Jin Kim,Bum Soo Kim,Hyeon–Cheol Gwon,Seung‐Hyuk Choi
出处
期刊:American Journal of Cardiology [Elsevier BV]
卷期号:121 (12): 1505-1511 被引量:25
标识
DOI:10.1016/j.amjcard.2018.02.034
摘要

Limited data exist regarding the clinical outcomes of patients with diabetes mellitus (DM) after percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES), especially according to DM treatment. The purpose of this study was to compare clinical outcomes among patients without DM, with non-insulin-treated DM (non-ITDM), and with ITDM after PCI using second-generation DES. We analyzed 4,812 consecutive patients who underwent PCI using second-generation DES. Primary outcomes were patient-oriented composite outcome (a composite of all-cause mortality, any myocardial infarction, and any revascularization) at 3 years. Among the total population, 3,026 patients have no DM, 1,169 have non-ITDM, and 617 have ITDM. Patients with DM, regardless of non-ITDM and ITDM, showed significantly higher risk of patient-oriented composite outcome (21.0% vs 14.5%; adjusted hazard ratio [HRadj]1.41, 95% confidence interval [CI] 1.19 to 1.66, p <0.001), mainly driven by significantly higher risk of cardiac death and any revascularization compared with non-DM. Among DM population, ITDM showed significantly higher risk of cardiac death (7.7% vs 3.7%; HRadj 1.97, 95% CI 1.19 to 3.27, p = 0.009), any revascularization (17.0% vs 11.4%; HRadj 1.40, 95% CI 1.01 to 1.93, p = 0.041), and definite/probable stent thrombosis (1.7% vs 0.7%; HRadj 2.80, 95% CI 1.04 to 7.56, p = 0.042) compared with non-ITDM. In conclusion, even in the era of second-generation DES, patients with DM are at significantly higher risk of patient-oriented adverse events. Among these, patients with ITDM showed the highest risk of adverse events, mainly driven by higher risk of mortality, any revascularization, and definite/probable stent thrombosis. Limited data exist regarding the clinical outcomes of patients with diabetes mellitus (DM) after percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES), especially according to DM treatment. The purpose of this study was to compare clinical outcomes among patients without DM, with non-insulin-treated DM (non-ITDM), and with ITDM after PCI using second-generation DES. We analyzed 4,812 consecutive patients who underwent PCI using second-generation DES. Primary outcomes were patient-oriented composite outcome (a composite of all-cause mortality, any myocardial infarction, and any revascularization) at 3 years. Among the total population, 3,026 patients have no DM, 1,169 have non-ITDM, and 617 have ITDM. Patients with DM, regardless of non-ITDM and ITDM, showed significantly higher risk of patient-oriented composite outcome (21.0% vs 14.5%; adjusted hazard ratio [HRadj]1.41, 95% confidence interval [CI] 1.19 to 1.66, p <0.001), mainly driven by significantly higher risk of cardiac death and any revascularization compared with non-DM. Among DM population, ITDM showed significantly higher risk of cardiac death (7.7% vs 3.7%; HRadj 1.97, 95% CI 1.19 to 3.27, p = 0.009), any revascularization (17.0% vs 11.4%; HRadj 1.40, 95% CI 1.01 to 1.93, p = 0.041), and definite/probable stent thrombosis (1.7% vs 0.7%; HRadj 2.80, 95% CI 1.04 to 7.56, p = 0.042) compared with non-ITDM. In conclusion, even in the era of second-generation DES, patients with DM are at significantly higher risk of patient-oriented adverse events. Among these, patients with ITDM showed the highest risk of adverse events, mainly driven by higher risk of mortality, any revascularization, and definite/probable stent thrombosis.
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