Impact of diabetes and early revascularization on the need for late and repeat procedures

Ady Orbach,Ronen Jaffe,Moshe Y Flugelman,Barak Zafrir,David A Halon,Ronen Rubinshtein,Basheer Karkabi

doi:10.1186/s12933-018-0669-0

Abstract

BackgroundCoronary artery disease often progresses more rapidly in diabetics, but the integrated impact of diabetes and early revascularization status on late or repeat revascularization in the contemporary era is less clear.MethodsCoronary angiography was performed in 12,420 patients between the years 2000–2015 and early revascularization status [none, percutaneous coronary intervention (PCI) or bypass surgery (CABG)] was determined. Subsequent revascularization procedures were recorded over a median follow-up of 67 months and its relation to diabetic and baseline revascularization status was studied.ResultsEarly revascularization status was none in 5391, PCI in 5682 and CABG in 1347 patients. Late revascularization rates were 10, 26 and 11.1% respectively. Diabetes was present in 37%; a stepwise relationship of diabetic status with late revascularization was observed: no diabetes (reference) 14.4%, non-insulin treated diabetes 21% (adjusted HR 1.35, 95% CI 1.23–1.49, p < 0.001) and insulin-treated diabetes 32.8% (adjusted HR 2.20, 95% CI 1.91–2.54, p < 0.001), which was similar in magnitude for each early revascularization state (none, PCI or CABG). Further revascularizations (≥ 2) were also significantly more common in diabetics, in particular if insulin-treated. Glycosylated hemoglobin level was moderately associated with late revascularization in diabetics after early PCI but not following diagnostic catheterization or CABG.ConclusionsDiabetic status graded by treatment, and in particular insulin therapy, is a strong predictor for late or repeat revascularization irrespective of early revascularization status. The high rate of repeat revascularization in diabetics following PCI remains a challenging issue.

Highlights

Diabetes mellitus is associated with a more complex, rapidly progressive and diffuse atherosclerosis, leading to unfavorable clinical outcomes and increased risk for post-procedural complications and need for repeat revascularization [1, 2]
In addition to the impact of early revascularization we examined the impact of diabetic status and baseline glycemic control on the need for late revascularization in this symptomatic diabetic cohort referred for coronary angiography after the year 2000
Patients referred to CABG were older, included a higher proportion of men and had higher rates of diabetes and peripheral vascular disease but lower body mass index (BMI) (Table 1)

Summary

Introduction

Diabetes mellitus is associated with a more complex, rapidly progressive and diffuse atherosclerosis, leading to unfavorable clinical outcomes and increased risk for post-procedural complications and need for repeat revascularization [1, 2]. The extent of coronary artery disease (CAD) differs widely amongst diabetics and a. In addition to the impact of early revascularization we examined the impact of diabetic status and baseline glycemic control on the need for late revascularization in this symptomatic diabetic cohort referred for coronary angiography after the year 2000. Coronary artery disease often progresses more rapidly in diabetics, but the integrated impact of diabetes and early revascularization status on late or repeat revascularization in the contemporary era is less clear

Methods

Results

Discussion

Conclusion