January 23, 2017
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After PCI, diabetes linked to higher mortality only in insulin-treated patients

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Among patients undergoing PCI for stable CAD or ACS, diabetic status was associated with higher mortality only in those treated with insulin, according to recent findings.

In the retrospective analysis, researchers assessed prospectively culled data on 9,224 patients who underwent PCI between March 2008 and December 2011 at a tertiary center in Newcastle-upon Tyne, United Kingdom. The patient population consisted of 7,652 nondiabetic patients, 1,116 patients with diabetes not being treated with insulin and 456 patients with diabetes being treated with insulin.

The researchers found that, at baseline, the youngest patients were in the non-diabetes group, and the proportion of female patients was highest in the insulin-treated diabetes group vs. other groups. Both diabetic cohorts had higher proportions of patients with known history of hypertension, hypercholesterolemia, MI, cerebral vascular disease, peripheral vascular disease and prior cardiac revascularization vs. the non-diabetes cohort.

Patients with diabetes had higher rates of multivessel CAD, renal impairment and noncoronary vascular disease, with the highest rates of these conditions seen in patients treated with insulin. A trend was observed toward higher usage of drug-eluting stents in patients treated with insulin vs. other groups (P = .059).

The overall 30-day rate of mortality was 2.4%. A logistic regression model revealed that, compared with patients without diabetes, those with diabetes not treated with insulin had no significant difference in 30-day mortality (adjusted OR = 1.28; 95% CI, 0.81-2.03), but those treated with insulin had elevated risk for 30-day mortality (adjusted OR = 2.82; 95% CI, 1.61-4.94).

The median follow-up period was 641 days. During this follow-up, the longer-term, post-30-day mortality rate was 5.3% (n = 695) overall. A Cox proportional hazard model revealed that vs. patients without diabetes, the group with diabetes without insulin treatment had a longer-term HR of 1.15 (95% CI, 0.88-1.49) and the insulin-treated group had a longer-term HR of 1.88 (95% CI, 1.38-2.55). Results were similar in cases of elective PCI, urgent PCI and emergency PCI.

This large observational study of contemporary PCI practice demonstrates higher post-PCI mortality in diabetic patients treated with insulin but not in those treated with diet or oral hypoglycemics in comparison to nondiabetic patients,” the researchers wrote. “The finding in relation to the noninsulin-treated diabetic population is both novel and important and in a ‘real-world’ population validates the recommendations of national guidelines to aggressively control [CV] risk factors and to carefully select cases appropriate for PCI as these appear to translate to mortality benefits in the population with obstructive [CAD] undergoing PCI.by Jennifer Byrne

Disclosure: The researchers report no relevant financial disclosures.