title: Long-term outcomes of older diabetic patients after percutaneous coronary stenting in the United States: a report from the National Cardiovascular Data Registry, 2004 to 2008.
abstract: OBJECTIVE
  The purpose of this study was to characterize long-term outcomes of percutaneous coronary intervention (PCI) in elderly diabetic patients in routine practice.
  
  
  BACKGROUND
  Although drug-eluting stent (DES) implantation in diabetic patients is common practice, pivotal randomized trials enrolled <2,500 diabetic patients, most of whom were <65 years of age.
  
  
  METHODS
  Data from 405,679 patients ≥65 years old (33% had diabetes mellitus, of whom 9.8% had insulin-treated diabetes mellitus [ITDM], and 23.3% had noninsulin-treated diabetes mellitus [NITDM]) undergoing PCI from 2004 to 2008 at 946 U.S. hospitals were linked with Medicare inpatient claims data.
  
  
  RESULTS
  Over 18.4 months median follow-up (25th to 75th percentile: 8.0 to 30.8 months), ITDM/NITDM were associated with significantly increased adjusted hazards of death (hazard ratio [HR]: 1.91 [95% confidence interval (CI): 1.86 to 1.96], p < 0.001/HR: 1.32 [95% CI: 1.29 to 1.35], p < 0.001) and myocardial infarction (HR: 1.87 [95% CI: 1.79 to 1.95], p < 0.001/HR: 1.29 [95% CI: 1.25 to 1.34], p < 0.001) compared with nondiabetic patients. The adjusted hazard of undergoing additional revascularization procedures (HR: 1.14 [95% CI: 1.10 to 1.18, p < 0.001/HR: 1.08 [95% CI: 1.05 to 1.10], p < 0.001) and subsequent hospitalization for bleeding (HR: 1.40 [95% CI: 1.31 to 1.50], p < 0.001/HR: 1.18 [95% CI: 1.13 to 1.24], p < 0.001) were also significantly increased. Compared with nondiabetic patients, there were similar excess risks associated with ITDM/NITDM in patients selected for DES and BMS use; selection for use of DES was associated with reductions in death in ITDM/NITDM and myocardial infarction in ITDM, but not NITDM. There were no significant interactions between diabetes status and stent type for revascularization or bleeding.
  
  
  CONCLUSIONS
  One-third of older patients undergoing PCI have diabetes. After adjustment for other comorbidities, diabetes, particularly ITDM, remains independently and strongly associated with increased long-term adverse events after both DES and BMS implantation.
authors.affiliation: Heart South, Alabaster, and University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: William B
authors.initials: WB
authors.lastname: Hillegass
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
authors.forename: Lloyd W
authors.initials: LW
authors.lastname: Klein
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Brennan
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.forename: David
authors.initials: D
authors.lastname: Dai
authors.forename: Eric L
authors.initials: EL
authors.lastname: Eisenstein
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000639:trends; D011446:Prospective Studies; D012042:Registries; D015607:Stents / Q000009:adverse effects / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology