Abstract
Introduction and objectivesPatients with type 2 diabetes (T2D) and stable coronary artery disease (CAD) previously revascularized with percutaneous coronary intervention (PCI) are at high risk of recurrent ischemic events. We aimed to provide real-world insights into the clinical characteristics and management of this clinical population, excluding patients with a history of myocardial infarction (MI) or stroke, using Natural Language Processing (NLP) technology.MethodsThis is a multicenter, retrospective study based on the secondary use of 2014–2018 real-world data captured in the Electronic Health Records (EHRs) of 1,579 patients (0.72% of the T2D population analyzed; n = 217,632 patients) from 12 representative hospitals in Spain. To access the unstructured clinical information in EHRs, we used the EHRead® technology, based on NLP and machine learning. Major adverse cardiovascular events (MACE) were considered: MI, ischemic stroke, urgent coronary revascularization, and hospitalization due to unstable angina. The association between MACE rates and the variables included in this study was evaluated following univariate and multivariate approaches.ResultsMost patients were male (72.13%), with a mean age of 70.5±10 years. Regarding T2D, most patients were non-insulin-dependent T2D (61.75%) with high prevalence of comorbidities. The median (Q1-Q3) duration of follow-up was 1.2 (0.3–4.5) years. Overall, 35.66% of patients suffered from at least one MACE during follow up. Using a Cox Proportional Hazards regression model analysis, several independent factors were associated with MACE during follow up: CAD duration (p < 0.001), COPD/Asthma (p = 0.021), heart valve disease (p = 0.031), multivessel disease (p = 0.005), insulin treatment (p < 0.001), statins treatment (p < 0.001), and clopidogrel treatment (p = 0.039).ConclusionsOur results showed high rates of MACE in a large real-world series of PCI-revascularized patients with T2D and CAD with no history of MI or stroke. These data represent a potential opportunity to improve the clinical management of these patients.
Highlights
Type 2 diabetes (T2D) has reached epidemic proportions globally due to a steady increase in life expectancy, high prevalence of obesity and sedentary lifestyle, and pervasive unhealthy eating habits [1]
Using a Cox Proportional Hazards regression model analysis, several independent factors were associated with Major adverse cardiovascular events (MACE) during follow up: coronary artery disease (CAD) duration (p < 0.001), Chronic obstructive pulmonary disease (COPD)/Asthma (p = 0.021), heart valve disease (p = 0.031), multivessel disease (p = 0.005), insulin treatment (p < 0.001), statins treatment (p < 0.001), and clopidogrel treatment (p = 0.039)
Our results showed high rates of MACE in a large real-world series of percutaneous coronary intervention (PCI)-revascularized patients with T2D and CAD with no history of myocardial infarction (MI) or stroke
Summary
Type 2 diabetes (T2D) has reached epidemic proportions globally due to a steady increase in life expectancy, high prevalence of obesity and sedentary lifestyle, and pervasive unhealthy eating habits [1]. CAD is the main cause of mortality in patients with T2D, and diabetes leads to a 2- to 4-fold increased risk of death due to heart disease [7, 8]. Approximately one third of patients undergoing percutaneous coronary intervention (PCI) are diabetic [8]. PCI procedures, with drug-eluting stents, have proven successful in the management of stable angina and improving quality of life in patients with diabetes and CAD [9]
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