Impact of diabetes mellitus on long-term clinical outcomes of patients on chronic hemodialysis after percutaneous coronary intervention.
BACKGROUND
End-stage renal disease (ESRD) is known to correlate with poor outcome in patients undergoing percutaneous coronary intervention (PCI). This study examines the impact of diabetes mellitus (DM) on the long-term outcome of patients with ESRD on chronic hemodialysis.


METHODS
A cohort of patients with ESRD on chronic hemodialysis, who underwent PCI with drug-eluting stents, was followed for 1 year. The clinical outcome in this population was compared retrospectively based on the presence of DM. Major adverse cardiac events (MACE) as the composite of all-cause death, Q-wave myocardial infarction and target lesion revascularization (TLR), as well as TLR as an individual outcome, were the main end points of the study.


RESULTS
In the study cohort (n = 198), 48.5% had DM. Diabetic patients were more commonly female. The lesion characteristics were similar between groups except for more frequent saphenous vein graft intervention in nondiabetics. At 1-year follow-up there was no difference in the rate of MACE between diabetic and nondiabetic patients (40.4% vs. 39.3%, respectively, p = 0.89), driven primarily by a very high mortality rate (1-year overall mortality of 33.5%). After adjustment for the relevant clinical co-variables, DM was not associated with the composite end point. However, diabetic patients had a significantly higher incidence of 1-year TLR compared to nondiabetics (13.8% vs. 3.6%, respectively, p = 0.04).


CONCLUSIONS
The prognosis of patients with ESRD after PCI is dismal with a very high overall mortality rate regardless of the presence of DM. Patients with ESRD appear to be at higher risk for the need of revascularization.
Washington Hospital Center, Washington, DC 20010, USA.
Gabriel L
GL
Sardi
Gabriel
G
Maluenda
Rebecca
R
Torguson
Zhenyi
Z
Xue
William O
WO
Suddath
Kenneth M
KM
Kent
Joseph
J
Lindsay
Lowell F
LF
Satler
Augusto D
AD
Pichard
Ron
R
Waksman
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015897:Comorbidity; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000453:epidemiology / Q000628:therapy; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000628:therapy; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000628:therapy; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D019233:Retreatment / Q000706:statistics & numerical data