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Title: Gradient of outcomes by treatment intensity in patients with diabetes mellitus undergoing percutaneous coronary intervention.
Author: Biswas, S.
Dinh, D.
Lefkovits, J.
Ajani, A.
Duffy, S.
Brennan, A.
Chan, W.
Bluzstein, D.
Clark, D.
Hiew, C.
Oqueli, Ernesto
Reid, C.
Stub, D.
Eccleston, D.
Issue Date: 2019
Conference Name: 67th Cardiac Society of Australia and New Zealand Annual Scientific Meeting, the International Society for Heart Research Australasian Section Annual Scientific Meeting and the 13th Annual Australia and New Zealand Endovascular Therapies Meeting.
Conference Date: August 8th-11th
Conference Place: Adelaide, Australia
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.
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Internal ID Number: 01374
Type: Conference
Appears in Collections:Research Output

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