Long-term outcomes of percutaneous coronary intervention in patients with diabetes mellitus: results from a large multi-centre Australian Registry.

Abstract

Background: Advances in diabetes management, particularly widespread use of SGLT-2 inhibitors, have result in cardiovascular risk reduction but further analysis of percutaneous coronary intervention (PCI) outcomes in diabetics is required. Method: We prospectively enrolled 20,393 patients in the Melbourne Interventional Group (MIG) Registry from 2005-2014. Patient, procedural characteristics and clinical outcomes were compared by DM status, with target-vessel revascularisation (TVR) and myocardial infarction (MI) used as markers of PCI durability. Results: Patients with DM were more likely to be female, obese and have renal impairment ( p < 0.001). DM patients were more likely to receive drug-eluting stents (DES) than bare-metal stents (BMS) ( p < 0.001). There was no difference between groups in stent length, however those with DM received smaller diameter stents ( p < 0.001) and more often completed ≥12 months of dual antiplatelet therapy ( p < 0.05). There was no difference in TVR ( p = 0.25) or MI ( p = 0.1) at 30 days. However at 12 months, rates of TVR and MI were significantly increased in patients with DM ( p < 0.001). Subgroup analysis showed highest TVR rates at 12 months in insulin-treated diabetics and those receiving BMS. Conclusion: Despite advances in drug and device therapy, patients with DM experience higher rates of adverse outcomes including late TVR and MI post PCI, emphasising the importance of optimal drug therapy and DES use in patients with DM.