title: Temporal changes in the outcomes of patients with diabetes mellitus undergoing percutaneous coronary intervention in the National Heart, Lung, and Blood Institute dynamic registry.
abstract: BACKGROUND
  Patients with diabetes mellitus (DM) are at higher risk for adverse outcomes following percutaneous coronary intervention (PCI).
  
  
  METHODS
  To determine whether outcomes have improved over time, we analyzed data from 2,838 consecutive patients with medically treated DM, including 1,066 patients (37.6%) treated with insulin, in the National Heart, Lung, and Blood Institute Dynamic Registry undergoing PCI registered in waves 1 (1997-1998), 2 (1999), 3 (2001-2002), 4 (2004), and 5 (2006). We compared baseline demographics and 1-year outcomes in the overall cohort and in analyses stratified by recruitment wave and insulin use.
  
  
  RESULTS
  Crude mortality rates by chronological wave were 9.5%, 12.5%, 8.9%, 11.6%, and 6.6% (P value(trend) = .33) among those treated with insulin and, respectively, 9.7%, 6.5%, 4.1%, 5.4%, and 4.7% (P value(trend) = .006) among patients treated with oral agents,. The adjusted hazard ratios of death, myocardial infarction (MI), and overall major adverse cardiovascular events (death, MI, revascularization) in insulin-treated patients with DM in waves 2 to 5 as compared with wave 1 were either higher or the same. In contrast, the similar adjusted hazard ratios for oral agent-treated patients with DM were either similar or lower.
  
  
  CONCLUSIONS
  Significant improvements over time in adverse events by 1 year were detected in patients with DM treated with oral agents. In insulin-treated diabetic patients, despite lower rates of repeat revascularization over time, death and MI following PCI have not significantly improved. These findings underscore the need for continued efforts at optimizing outcomes among patients with DM undergoing PCI, especially those requiring insulin treatment.
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA. elizabeth.holper@utsouthwestern.edu
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Holper
authors.forename: J Dawn
authors.initials: JD
authors.lastname: Abbott
authors.forename: Suresh
authors.initials: S
authors.lastname: Mulukutla
authors.forename: Helen
authors.initials: H
authors.lastname: Vlachos
authors.forename: Faith
authors.initials: F
authors.lastname: Selzer
authors.forename: Darren
authors.initials: D
authors.lastname: McGuire
authors.forename: David P
authors.initials: DP
authors.lastname: Faxon
authors.forename: Warren
authors.initials: W
authors.lastname: Laskey
authors.forename: Vankeepuram S
authors.initials: VS
authors.lastname: Srinivas
authors.forename: Oscar C
authors.initials: OC
authors.lastname: Marroquin
authors.forename: Alice K
authors.initials: AK
authors.lastname: Jacobs
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000628:therapy*; D048909:Diabetes Complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome