Comparison of Long-Term Outcomes After Percutaneous Coronary Intervention in Patients With Insulin-Treated Versus Non-Insulin Treated Diabetes Mellitus
There are conflicting data on whether patients with insulin-treated diabetes mellitus (ITDM) have poorer outcomes compared with non-insulin treated diabetic (non-ITDM) patients following percutaneous coronary intervention (PCI). We therefore compared clinical outcomes following PCI in ITDM versus no...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
2021
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| Subjects: | |
| Online Access: | http://purl.org/au-research/grants/nhmrc/1111170 http://hdl.handle.net/20.500.11937/93771 |
| _version_ | 1848765785513656320 |
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| author | Biswas, S. Dinh, D. Andrianopoulos, N. Lefkovits, J. Ajani, A. Duffy, S.J. Chan, W. Walton, A. Brennan, A. Clark, D.J. Hiew, C. Oqueli, E. Reid, Christopher Stub, D. Eccleston, D. |
| author_facet | Biswas, S. Dinh, D. Andrianopoulos, N. Lefkovits, J. Ajani, A. Duffy, S.J. Chan, W. Walton, A. Brennan, A. Clark, D.J. Hiew, C. Oqueli, E. Reid, Christopher Stub, D. Eccleston, D. |
| author_sort | Biswas, S. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | There are conflicting data on whether patients with insulin-treated diabetes mellitus (ITDM) have poorer outcomes compared with 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 underwent PCI between 2005 and 2014 in a large multicenter registry and dichotomized 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 hypoglycemic 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 to 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 to1.55, 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. |
| first_indexed | 2025-11-14T11:40:46Z |
| format | Journal Article |
| id | curtin-20.500.11937-93771 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T11:40:46Z |
| publishDate | 2021 |
| publisher | EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-937712024-01-09T07:30:51Z Comparison of Long-Term Outcomes After Percutaneous Coronary Intervention in Patients With Insulin-Treated Versus Non-Insulin Treated Diabetes Mellitus Biswas, S. Dinh, D. Andrianopoulos, N. Lefkovits, J. Ajani, A. Duffy, S.J. Chan, W. Walton, A. Brennan, A. Clark, D.J. Hiew, C. Oqueli, E. Reid, Christopher Stub, D. Eccleston, D. Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology DRUG-ELUTING STENTS ACUTE MYOCARDIAL-INFARCTION SURVIVAL Aged Angina, Stable Angina, Unstable Atherectomy, Coronary Comorbidity Coronary Artery Disease Diabetes Mellitus Drug-Eluting Stents Female Humans Hypoglycemic Agents Insulin Male Middle Aged Non-ST Elevated Myocardial Infarction Percutaneous Coronary Intervention Prognosis ST Elevation Myocardial Infarction Stroke Volume Ventricular Dysfunction, Left Humans Angina, Unstable Ventricular Dysfunction, Left Diabetes Mellitus Insulin Hypoglycemic Agents Stroke Volume Prognosis Atherectomy, Coronary Comorbidity Aged Middle Aged Female Male Coronary Artery Disease Drug-Eluting Stents Angina, Stable Percutaneous Coronary Intervention Non-ST Elevated Myocardial Infarction ST Elevation Myocardial Infarction There are conflicting data on whether patients with insulin-treated diabetes mellitus (ITDM) have poorer outcomes compared with 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 underwent PCI between 2005 and 2014 in a large multicenter registry and dichotomized 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 hypoglycemic 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 to 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 to1.55, 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. 2021 Journal Article http://hdl.handle.net/20.500.11937/93771 10.1016/j.amjcard.2021.02.025 English http://purl.org/au-research/grants/nhmrc/1111170 EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC restricted |
| spellingShingle | Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology DRUG-ELUTING STENTS ACUTE MYOCARDIAL-INFARCTION SURVIVAL Aged Angina, Stable Angina, Unstable Atherectomy, Coronary Comorbidity Coronary Artery Disease Diabetes Mellitus Drug-Eluting Stents Female Humans Hypoglycemic Agents Insulin Male Middle Aged Non-ST Elevated Myocardial Infarction Percutaneous Coronary Intervention Prognosis ST Elevation Myocardial Infarction Stroke Volume Ventricular Dysfunction, Left Humans Angina, Unstable Ventricular Dysfunction, Left Diabetes Mellitus Insulin Hypoglycemic Agents Stroke Volume Prognosis Atherectomy, Coronary Comorbidity Aged Middle Aged Female Male Coronary Artery Disease Drug-Eluting Stents Angina, Stable Percutaneous Coronary Intervention Non-ST Elevated Myocardial Infarction ST Elevation Myocardial Infarction Biswas, S. Dinh, D. Andrianopoulos, N. Lefkovits, J. Ajani, A. Duffy, S.J. Chan, W. Walton, A. Brennan, A. Clark, D.J. Hiew, C. Oqueli, E. Reid, Christopher Stub, D. Eccleston, D. Comparison of Long-Term Outcomes After Percutaneous Coronary Intervention in Patients With Insulin-Treated Versus Non-Insulin Treated Diabetes Mellitus |
| title | Comparison of Long-Term Outcomes After Percutaneous Coronary Intervention in Patients With Insulin-Treated Versus Non-Insulin Treated Diabetes Mellitus |
| title_full | Comparison of Long-Term Outcomes After Percutaneous Coronary Intervention in Patients With Insulin-Treated Versus Non-Insulin Treated Diabetes Mellitus |
| title_fullStr | Comparison of Long-Term Outcomes After Percutaneous Coronary Intervention in Patients With Insulin-Treated Versus Non-Insulin Treated Diabetes Mellitus |
| title_full_unstemmed | Comparison of Long-Term Outcomes After Percutaneous Coronary Intervention in Patients With Insulin-Treated Versus Non-Insulin Treated Diabetes Mellitus |
| title_short | Comparison of Long-Term Outcomes After Percutaneous Coronary Intervention in Patients With Insulin-Treated Versus Non-Insulin Treated Diabetes Mellitus |
| title_sort | comparison of long-term outcomes after percutaneous coronary intervention in patients with insulin-treated versus non-insulin treated diabetes mellitus |
| topic | Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology DRUG-ELUTING STENTS ACUTE MYOCARDIAL-INFARCTION SURVIVAL Aged Angina, Stable Angina, Unstable Atherectomy, Coronary Comorbidity Coronary Artery Disease Diabetes Mellitus Drug-Eluting Stents Female Humans Hypoglycemic Agents Insulin Male Middle Aged Non-ST Elevated Myocardial Infarction Percutaneous Coronary Intervention Prognosis ST Elevation Myocardial Infarction Stroke Volume Ventricular Dysfunction, Left Humans Angina, Unstable Ventricular Dysfunction, Left Diabetes Mellitus Insulin Hypoglycemic Agents Stroke Volume Prognosis Atherectomy, Coronary Comorbidity Aged Middle Aged Female Male Coronary Artery Disease Drug-Eluting Stents Angina, Stable Percutaneous Coronary Intervention Non-ST Elevated Myocardial Infarction ST Elevation Myocardial Infarction |
| url | http://purl.org/au-research/grants/nhmrc/1111170 http://hdl.handle.net/20.500.11937/93771 |