title: Impact of diabetes mellitus on long-term follow-up of percutaneous coronary intervention based on clinical presentation of coronary artery disease.
abstract: OBJECTIVE
  In the drug-eluting stent (DES) era, diabetes mellitus is still associated with poor clinical and angiographic outcome after PCI. Whether this phenomenon is exacerbated in the setting of acute coronary syndromes (ACS) is unclear. We investigated the long-term interaction of diabetes mellitus and clinical presentation in patients treated with percutaneous coronary intervention (PCI).
  
  
  METHODS
  Consecutive patients undergoing PCI and DES implantation were retrospectively analyzed. The 3-year composite of death, non-fatal myocardial infarction (MI) or target vessel revascularization (TVR) was assessed.
  
  
  RESULTS
  Four subgroups of patients were identified: diabetes mellitus and ACS (n = 302); diabetes mellitus and no-ACS (n = 191); no-diabetes mellitus and ACS (n = 573); no-diabetes mellitus and no-ACS (n = 396). Compared to non-diabetes mellitus, diabetes mellitus patients experienced higher 3-year rates of death, non-fatal MI or TVR (32.3 vs. 21.9%, P < 0.001). Diabetes mellitus was significantly associated with the composite of death, non-fatal MI or TVR in the no-ACS group [adjusted hazard ratio (AHR) 1.307, 95% confidence interval (CI) 1.090-1.566, P = 0.004] and, albeit to a lesser extent, in the ACS group (AHR 1.177, 95% CI 1.006-1.377, P = 0.041). No statistically significant interaction was observed between diabetes mellitus and clinical presentation (P for interaction = 0.802).
  
  
  CONCLUSIONS
  No significant interaction between diabetes mellitus and clinical presentation was noted in this study. The high rates of cardiac events observed in diabetes mellitus patients despite recent advances in interventional techniques outline the need for a multidisciplinary approach in the management of diabetes mellitus patients, including optimization of glycemic control, aggressive medical therapy and more complete coronary revascularization.
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Cettina
authors.initials: C
authors.lastname: Ruperto
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.forename: Anita
authors.initials: A
authors.lastname: Blundo
authors.forename: Piera
authors.initials: P
authors.lastname: Capranzano
authors.forename: Alessandra
authors.initials: A
authors.lastname: Sanfilippo
authors.forename: Anna
authors.initials: A
authors.lastname: Caggegi
authors.forename: Rita
authors.initials: R
authors.lastname: Bucalo
authors.forename: Valerio
authors.initials: V
authors.lastname: Giaimo
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D003920:Diabetes Mellitus / Q000503:physiopathology*; D054855:Drug-Eluting Stents; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology; D009204:Myocardial Revascularization; D012189:Retrospective Studies; D016896:Treatment Outcome