Impact of diabetes mellitus on long-term follow-up of percutaneous coronary intervention based on clinical presentation of coronary artery disease

Abstract

In the drug-eluting stent (DES) era, diabetes mellitus is still associated with poor clinical and angiographic outcome after PCI. Whether this phenomenon is exacerbated in the setting of acute coronary syndromes (ACS) is unclear. We investigated the long-term interaction of diabetes mellitus and clinical presentation in patients treated with percutaneous coronary intervention (PCI). Consecutive patients undergoing PCI and DES implantation were retrospectively analyzed. The 3-year composite of death, non-fatal myocardial infarction (MI) or target vessel revascularization (TVR) was assessed. Four subgroups of patients were identified: diabetes mellitus and ACS (n = 302); diabetes mellitus and no-ACS (n = 191); no-diabetes mellitus and ACS (n = 573); no-diabetes mellitus and no-ACS (n = 396). Compared to non-diabetes mellitus, diabetes mellitus patients experienced higher 3-year rates of death, non-fatal MI or TVR (32.3 vs. 21.9%, P < 0.001). Diabetes mellitus was significantly associated with the composite of death, non-fatal MI or TVR in the no-ACS group [adjusted hazard ratio (AHR) 1.307, 95% confidence interval (CI) 1.090-1.566, P = 0.004] and, albeit to a lesser extent, in the ACS group (AHR 1.177, 95% CI 1.006-1.377, P = 0.041). No statistically significant interaction was observed between diabetes mellitus and clinical presentation (P for interaction = 0.802). No significant interaction between diabetes mellitus and clinical presentation was noted in this study. The high rates of cardiac events observed in diabetes mellitus patients despite recent advances in interventional techniques outline the need for a multidisciplinary approach in the management of diabetes mellitus patients, including optimization of glycemic control, aggressive medical therapy and more complete coronary revascularization.