J Am Coll Cardiol. 2012 Dec 4;60(22):2280-9. doi: 10.1016/j.jacc.2012.08.993.
Long-term outcomes of older diabetic patients after percutaneous coronary stenting in the United States: a report from the National Cardiovascular Data Registry, 2004 to 2008.
Hillegass WB, Patel MR, Klein LW, Gurm HS, Brennan JM, Anstrom KJ, Dai D, Eisenstein EL, Peterson ED, Messenger JC, Douglas PS.
SourceHeart South, Alabaster, and University of Alabama at Birmingham, Birmingham, Alabama, USA.
OBJECTIVES:The purpose of this study was to characterize long-term outcomes of percutaneous coronary intervention (PCI) in elderly diabetic patients in routine practice.
BACKGROUND:Although drug-eluting stent (DES) implantation in diabetic patients is common practice, pivotal randomized trials enrolled <2 age.="" diabetic="" most="" of="" p="" patients="" were="" whom="" years="">2>
METHODS:Data from 405,679 patients ≥65 years old (33% had diabetes mellitus, of whom 9.8% had insulin-treated diabetes mellitus [ITDM], and 23.3% had noninsulin-treated diabetes mellitus [NITDM]) undergoing PCI from 2004 to 2008 at 946 U.S. hospitals were linked with Medicare inpatient claims data.
RESULTS:Over 18.4 months median follow-up (25th to 75th percentile: 8.0 to 30.8 months), ITDM/NITDM were associated with significantly increased adjusted hazards of death (hazard ratio [HR]: 1.91 [95% confidence interval (CI): 1.86 to 1.96], p < 0.001/HR: 1.32 [95% CI: 1.29 to 1.35], p < 0.001) and myocardial infarction (HR: 1.87 [95% CI: 1.79 to 1.95], p < 0.001/HR: 1.29 [95% CI: 1.25 to 1.34], p < 0.001) compared with nondiabetic patients. The adjusted hazard of undergoing additional revascularization procedures (HR: 1.14 [95% CI: 1.10 to 1.18, p < 0.001/HR: 1.08 [95% CI: 1.05 to 1.10], p < 0.001) and subsequent hospitalization for bleeding (HR: 1.40 [95% CI: 1.31 to 1.50], p < 0.001/HR: 1.18 [95% CI: 1.13 to 1.24], p < 0.001) were also significantly increased. Compared with nondiabetic patients, there were similar excess risks associated with ITDM/NITDM in patients selected for DES and BMS use; selection for use of DES was associated with reductions in death in ITDM/NITDM and myocardial infarction in ITDM, but not NITDM. There were no significant interactions between diabetes status and stent type for revascularization or bleeding.
CONCLUSIONS:One-third of older patients undergoing PCI have diabetes. After adjustment for other comorbidities, diabetes, particularly ITDM, remains independently and strongly associated with increased long-term adverse events after both DES and BMS implantation.
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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