title: Thirty-year trends in outcomes of percutaneous coronary interventions in diabetic patients.
abstract: OBJECTIVE
  To characterize in-hospital and long-term outcomes after percutaneous coronary interventions (PCIs) in patients with diabetes mellitus (DM).
  
  
  METHODS
  Patients who underwent PCIs were grouped by era: group 1, October 9, 1979, to December 31, 1989 (408 with DM and 2684 without DM); group 2, January 1, 1990, to December 31, 1996 (1170 and 4664); group 3, January 1, 1997, to December 31, 2003 (2032 and 6584); and group 4, January 1, 2004, to December 31, 2008 (1412 and 4141). The main outcome measures were in-hospital mortality, major adverse cardiovascular events, long-term mortality, composites of mortality with revascularization, and ischemic events.
  
  
  RESULTS
  Patients with DM had significant declines in in-hospital adverse outcomes over time. These declines were similar to those observed in patients without DM. After adjusting for baseline risk, there was no significant change in the association between DM and in-hospital death or in-hospital major adverse cardiovascular events over time. The use of aspirin, β-blockers, angiotensin-converting enzyme inhibitors, lipid-lowering drugs, and thienopyridines all increased over time. The effect of DM on long-term survival and survival free of revascularization did not change significantly from group 2 to group 4. However, the effect of DM on survival free of myocardial infarction and stroke was reduced significantly, from a hazard ratio (95% CI) of 1.71 (1.51-1.92) in group 2 to 1.39 (1.20-1.60) in group 4 (P=.04).
  
  
  CONCLUSIONS
  Over 30 years, the improving outcomes in patients with diabetes who underwent PCIs have been similar to improvements in patients without DM. However, the risk-adjusted association of DM with long-term death, myocardial infarction, and stroke has decreased in the current era (group 4) compared with the bailout stent era (group 2).
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA. singh.mandeep@mayo.edu
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: Robert L
authors.initials: RL
authors.lastname: Frye
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D048909:Diabetes Complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents