Journal Article

Effect of Diabetes on Long-Term Mortality Following Contemporary Percutaneous Coronary Intervention

Babak A. Vakili, Warren Sherman, David L. Brown, Sean R. Wilson, Timothy A. Sanborn

2004

Overview

Effect of Diabetes on Long-Term Mortality Following Contemporary Percutaneous Coronary Intervention Analysis of 4,284 cases Sean R. Wilson , BS , Babak A. Vakili , MD , Warren Sherman , MD , Timothy A. Sanborn , MD and David L. Brown , MD Department of Medicine (Cardiology), Beth Israel Medical Center, New York, New York Address correspondence and reprint requests to David L. Brown, MD, Division of Cardiovascular Interventions, Beth Israel Medical Center—Dazian 11, First Avenue at 16th St., New York, NY 10003. E-mail: dabrown{at}chpnet.org Abstract OBJECTIVE —Diabetic patients are known to have reduced long-term survival following percutaneous transluminal coronary angioplasty compared with nondiabetic patients. However, it is unknown whether this survival disadvantage has persisted in the era of contemporary percutaneous coronary intervention (PCI) techniques, which include the widespread use of stents and the availability of platelet glycoprotein (GP) IIb/IIIa inhibitors. RESEARCH DESIGN AND METHODS —Three hospitals in New York City contributed prospectively defined data on 4,284 patients undergoing PCI. The primary end point was all-cause mortality following hospital discharge for PCI. RESULTS —Hypertension, renal insufficiency, and renal failure requiring dialysis were all more common in diabetic patients, whereas active smoking was less frequent. Congestive heart failure on admission was more common in diabetic than nondiabetic patients (7.7 vs. 4.0%, P < 0.001). Stents were placed in 78% of nondiabetic patients and 75% of diabetic patients ( P = 0.045). Platelet GP IIb/IIIa antagonists were administered to 23% of nondiabetic and 24% of diabetic patients ( P = NS). At a mean follow-up of 3 years, mortality was 8% among nondiabetic patients and 13% for diabetic patients ( P < 0.001). After adjustment for differences in baseline characteristics between nondiabetic and diabetic patients, diabetes remained a significant independent hazard for late mortality (hazard ratio 1.462, 95% CI 1.169–1.828; P = 0.001). CONCLUSIONS —Following contemporary PCI, diabetic patients continue to have worse survival than nondiabetic patients. BARI, Bypass Angioplasty Revascularization Investigation CAD, coronary artery disease GP, glycoprotein MI, myocardial infarction PCI, percutaneous coronary intervention PTCA, percutaneous transluminal coronary angioplasty Footnotes Accepted February 5, 2004. Received August 6, 2003. DIABETES CARE

• Publisher: American Diabetes Association