Effect of diabetes on long-term mortality following contemporary percutaneous coronary intervention: analysis of 4,284 cases.
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.


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.
Wilson
Sean R
SR
Department of Medicine (Cardiology), Beth Israel Medical Center, New York, New York 10003, USA.
Vakili
Babak A
BA
Sherman
Warren
W
Sanborn
Timothy A
TA
Brown
David L
DL
D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000453:epidemiology / Q000401:mortality; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000401:mortality* / Q000628:therapy*; D003328:Coronary Thrombosis / Q000453:epidemiology / Q000401:mortality; D003404:Creatinine / Q000097:blood; D003925:Diabetic Angiopathies / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
D003404:Creatinine