Gradient of outcomes by treatment intensity in patients with diabetes mellitus undergoing percutaneous coronary intervention.

Abstract

Background: Patients with diabetes mellitus have been shown to have worse outcomes after percutaneous coronary intervention (PCI) than non-diabetics. However, the impact of the intensity of diabetes treatment on outcomes is unclear. Methods: We prospectively enrolled 4,579 patients with diabetes undergoing PCI in 2005 to 2014, in the multi-centre Melbourne Interventional Group registry. Demographic and procedural characteristics, and 12-month outcomes were compared in patients on insulin (ITDM) to those not on insulin (non-ITDM). Non-ITDM patients were further divided into diet control (diet-DM) and oral hypoglycaemic therapy (OHG-DM) groups. We then assessed the association of treatment intensity with 12-month outcomes adjusted for baseline clinical and lesion characteristics. Results: In total, the non-ITDM group included 3,468 patients (76%) while the ITDM group included 1,111 patients (24%). ITDM patients were more likely to be male, obese, have peripheral vascular disease and receive drug-eluting stents (all p < 0.001). On multivariable analysis, ITDM was an independent predictor of 12-month major adverse cardiovascular and cerebrovascular events (MACCE) (OR 1.26; 95% CI 1.02–1.55; p = 0.03). When the non-ITDM group was sub-divided, a progressively higher rate of 12-month mortality and MACCE with increasing treatment intensity, was observed ( p < 0.001) Conclusion: ITDM patients have higher rates of MACCE compared to non-ITDM patients 12 months following PCI. There is a clear gradient of risk of adverse outcomes with treatment escalation from diet control to OHG to insulin.