title: Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus.
abstract: OBJECTIVE
  To assess the mortality in patients with diabetes mellitus (DM) following percutaneous coronary intervention (PCI) according to their insulin requirement and PCI setting (elective, urgent, and emergency).
  
  
  BACKGROUND
  DM is a major risk factor to develop coronary artery disease (CAD). It is unclear if meticulous glycemic control and aggressive risk factor management in patients with DM has improved outcomes following PCI.
  
  
  METHODS
  Retrospective analysis of prospectively collected data on 9,224 patients treated with PCI at a regional tertiary center between 2008 and 2011.
  
  
  RESULTS
  About 7,652 patients were nondiabetics (non-DM), 1,116 had non-insulin treated diabetes mellitus (NITDM) and 456 had ITDM. Multi-vessel coronary artery disease, renal impairment and non-coronary vascular disease were more prevalent in DM patients. Overall 30-day mortality rate was 2.4%. In a logistic regression model, the adjusted odds ratios (95% confidence intervals [CI]) for 30-day mortality were 1.28 (0.81-2.03, P = 0.34) in NITDM and 2.82 (1.61-4.94, P < 0.001) in ITDM compared with non-DM. During a median follow-up period of 641 days, longer-term post-30 day mortality rate was 5.3%. In the Cox's proportional hazard model, the hazard ratios (95% CI) for longer-term mortality were 1.15 (0.88-1.49, P = 0.31) in NITDM and 1.88 (1.38-2.55, P < 0.001) in ITDM compared with non-DM group. Similar result was observed in all three different PCI settings.
  
  
  CONCLUSIONS
  In the modern era of aggressive cardiovascular risk factor control in diabetes, this study reveals higher mortality only in insulin-treated diabetic patients following PCI for stable coronary artery disease and acute coronary syndrome. Importantly, diabetic patients with good risk factor control and managed on diet or oral hypoglycemics have similar outcomes to the non-diabetic population. © 2016 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.
authors.affiliation: Cardiology Department, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom.
authors.forename: Awsan
authors.initials: A
authors.lastname: Noman
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom.
authors.forename: Karthik
authors.initials: K
authors.lastname: Balasubramaniam
authors.affiliation: Cardiology Department, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom.
authors.forename: M Hafez A
authors.initials: MHA
authors.lastname: Alhous
authors.affiliation: Cardiology Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Lee
authors.affiliation: Cardiology Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Jesudason
authors.affiliation: Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, United Kingdom.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Rashid
authors.affiliation: Cardiovascular Institute, Manchester University, Manchester, United Kingdom.|Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, United Kingdom.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom.|Cardiology Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom.
authors.forename: Azfar G
authors.initials: AG
authors.lastname: Zaman
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology / Q000401:mortality; D003328:Coronary Thrombosis / Q000209:etiology / Q000401:mortality; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D004630:Emergencies; D004739:England; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015607:Stents; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: diabetes mellitus; mortality; percutaneous coronary intervention