Long-Term Outcomes of Older Diabetic Patients After Percutaneous Coronary Stenting in the United States: A Report From the National Cardiovascular Data Registry, 2004 to 2008

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• 作者：William B. Hillegass ; MD ; MPH^? ; Manesh R. Patel ; MD^&dagger ; ; Lloyd W. Klein ; MD^&Dagger ; ; Hitinder S. Gurm ; MD^§ ; ; J. Matthew Brennan ; MD^&dagger ; ; Kevin J. Anstrom ; PhD^&dagger ; ; David Dai ; PhD^&dagger ; ; Eric L. Eisenstein ; DBA^&dagger ; ; Eric D. Peterson ; MD ; MPH^&dagger ; ; John C. Messenger ; MD^¡Î ; Pamela S. Douglas ; MD^&dagger ; ; ^{pamela.douglas@duke.edu}
• 关键词：coronary stents ; diabetes mellitus ; outcomes
• 刊名：Journal of the American College of Cardiology
• 出版年：2012
• 出版时间：4 December, 2012
• 年：2012
• 卷：60
• 期：22
• 页码：2280-2289
• 全文大小：1589 K

文摘

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Objectives

The purpose of this study was to characterize long-term outcomes of percutaneous coronary intervention (PCI) in elderly diabetic patients in routine practice.

Background

Although drug-eluting stent (DES) implantation in diabetic patients is common practice, pivotal randomized trials enrolled <2,500 diabetic patients, most of whom were <65 years of age.

Methods

Data from 405,679 patients ¡Ý65 years old (33 % had diabetes mellitus, of whom 9.8 % had insulin-treated diabetes mellitus [ITDM], and 23.3 % had noninsulin-treated diabetes mellitus [NITDM]) undergoing PCI from 2004 to 2008 at 946 U.S. hospitals were linked with Medicare inpatient claims data.

Results

Over 18.4 months median follow-up (25th to 75th percentile: 8.0 to 30.8 months), ITDM/NITDM were associated with significantly increased adjusted hazards of death (hazard ratio [HR]: 1.91 [95 % confidence interval (CI): 1.86 to 1.96], p < 0.001/HR: 1.32 [95 % CI: 1.29 to 1.35], p < 0.001) and myocardial infarction (HR: 1.87 [95 % CI: 1.79 to 1.95], p < 0.001/HR: 1.29 [95 % CI: 1.25 to 1.34], p < 0.001) compared with nondiabetic patients. The adjusted hazard of undergoing additional revascularization procedures (HR: 1.14 [95 % CI: 1.10 to 1.18, p < 0.001/HR: 1.08 [95 % CI: 1.05 to 1.10], p < 0.001) and subsequent hospitalization for bleeding (HR: 1.40 [95 % CI: 1.31 to 1.50], p < 0.001/HR: 1.18 [95 % CI: 1.13 to 1.24], p < 0.001) were also significantly increased. Compared with nondiabetic patients, there were similar excess risks associated with ITDM/NITDM in patients selected for DES and BMS use; selection for use of DES was associated with reductions in death in ITDM/NITDM and myocardial infarction in ITDM, but not NITDM. There were no significant interactions between diabetes status and stent type for revascularization or bleeding.

Conclusions

One-third of older patients undergoing PCI have diabetes. After adjustment for other comorbidities, diabetes, particularly ITDM, remains independently and strongly associated with increased long-term adverse events after both DES and BMS implantation.