(Circulation. 1996;94:1818-1825.)
© 1996 American Heart Association, Inc.
Articles |
Coronary Angioplasty in Diabetic Patients
The National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry
the University of Pittsburgh, Pa (K.E.K., K.M.D., W.Y., S.F.K.), and the University of Southern California, Los Angeles (D.P.F., J.W.C.).
Correspondence to Kevin E. Kip, University of Pittsburgh, Graduate School of Public Health, Epidemiology Data Coordinating Center, 127 Parran Hall, 130 DeSoto St, Pittsburgh, PA 15261. E-mail epidkek@vms.cis.pitt.edu.
Background Patients with diabetes mellitus are at increased risk of cardiovascular disease. To date, the baseline status and subsequent outcomes of diabetic coronary angioplasty (percutaneous transluminal coronary angioplasty, or PTCA) patients with advanced atherosclerotic disease and with procedures performed across North America have not been well characterized.
Methods and Results Data on baseline clinical and angiographic characteristics and short- and long-term outcomes of 281 diabetic and 1833 nondiabetic PTCA patients in the multicenter National Heart, Lung, and Blood Institute 1985-1986 PTCA Registry were analyzed. Diabetic patients were older, were more likely to be female, and had more comorbid baseline conditions, triple-vessel disease, and atherosclerotic lesions. Angiographic success and completeness of revascularization did not differ significantly, yet diabetic patients experienced more in-hospital death (women) and nonfatal myocardial infarction. Nine-year mortality was twice as high in diabetic patients (35.9% versus 17.9%). Similarly, 9-year rates of nonfatal myocardial infarction (29.0% versus 18.5%), bypass surgery (36.7% versus 27.4%), and repeat PTCA (43.7% versus 36.5%) were higher in diabetics than in nondiabetics. In multivariate analysis, diabetes remained a significant predictor of decreased 9-year survival and other untoward events.
Conclusions Compared with nondiabetic PTCA patients, diabetic patients have more extensive and diffuse atherosclerotic disease. Despite similar probability of angiographic success, diabetic patients are more likely to suffer in-hospital death (women) and nonfatal myocardial infarction. Long-term survival and freedom from myocardial infarction and coronary revascularization is also reduced in diabetic PTCA patients. Whether PTCA or coronary bypass surgery is more suitable for these patients is currently under investigation.
Key Words: myocardial infarction • diabetes mellitus • cardiovascular diseases • angioplasty • follow-up studies
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D. M. Shindler, S. T. Palmeri, T. A. Antonelli, L. A. Sleeper, J. Boland, T. P. Cocke, J. S. Hochman, and for the SHOCK Investigators Diabetes mellitus in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry J. Am. Coll. Cardiol., September 1, 2000; 36(3_Suppl_A): 1097 - 1103. [Abstract] [Full Text] [PDF]
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T. Hammoud, J.-F. Tanguay, and M. G. Bourassa Management of coronary artery disease: therapeutic options in patients with diabetes J. Am. Coll. Cardiol., August 1, 2000; 36(2): 355 - 365. [Abstract] [Full Text] [PDF]
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A.M. Lincoff and E.J. Topol Platelet glycoprotein IIb/IIIa inhibition during percutaneous coronary revascularization: what more needs to be proven? Eur. Heart J., June 1, 2000; 21(11): 863 - 867. [PDF]
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D. Hasdai, C. B. Granger, S. S. Srivatsa, D. A. Criger, S. G. Ellis, R. M. Califf, E. J. Topol, and D. R. Holmes Jr. Diabetes mellitus and outcome after primary coronary angioplasty for acute myocardial infarction: lessons from the GUSTO-IIb angioplasty substudy J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1502 - 1512. [Abstract] [Full Text] [PDF]
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J. Schofer, M. Schluter, T. Rau, F. Hammer, N. Haag, and D. G. Mathey Influence of treatment modality on angiographic outcome after coronary stenting in diabetic patients: a controlled study J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1554 - 1559. [Abstract] [Full Text] [PDF]
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S. P. Marso, A. M. Lincoff, S. G. Ellis, D. L. Bhatt, J.-F. Tanguay, N. S. Kleiman, T. Hammoud, J. E. Booth, S. K. Sapp, and E. J. Topol Optimizing the Percutaneous Interventional Outcomes for Patients With Diabetes Mellitus : Results of the EPISTENT (Evaluation of Platelet IIb/IIIa Inhibitor for Stenting Trial) Diabetic Substudy Circulation, December 21, 1999; 100(25): 2477 - 2484. [Abstract] [Full Text] [PDF]
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S. R. Steinhubl, K. Kottke-Marchant, D. J. Moliterno, M. L. Rosenthal, N. K. Godfrey, B. S. Coller, E. J. Topol, and A. M. Lincoff Attainment and Maintenance of Platelet Inhibition Through Standard Dosing of Abciximab in Diabetic and Nondiabetic Patients Undergoing Percutaneous Coronary Intervention Circulation, November 9, 1999; 100(19): 1977 - 1982. [Abstract] [Full Text] [PDF]
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P. R. Moreno, J. T. Fallon, A. M. Murcia, M. N. Leon, H. Simosa, V. Fuster, and I. F. Palacios Tissue characteristics of restenosis after percutaneous transluminal coronary angioplasty in diabetic patients J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1045 - 1049. [Abstract] [Full Text] [PDF]
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S. M. Grundy, I. J. Benjamin, G. L. Burke, A. Chait, R. H. Eckel, B. V. Howard, W. Mitch, S. C. Smith Jr, and J. R. Sowers Diabetes and Cardiovascular Disease : A Statement for Healthcare Professionals From the American Heart Association Circulation, September 7, 1999; 100(10): 1134 - 1146. [Full Text] [PDF]
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E. Van Belle, K. Abolmaali, C. Bauters, E. P. McFadden, J.-M. Lablanche, and M. E. Bertrand Restenosis, late vessel occlusion and left ventricular function six months after balloon angioplasty in diabetic patients J. Am. Coll. Cardiol., August 1, 1999; 34(2): 476 - 485. [Abstract] [Full Text] [PDF]
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H. Schunkert, L. Harrell, and I. F. Palacios Implications of small reference vessel diameter in patients undergoing percutaneous coronary revascularization J. Am. Coll. Cardiol., July 1, 1999; 34(1): 40 - 48. [Abstract] [Full Text] [PDF]
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S. P. Marso, S. G. Ellis, E. M. Tuzcu, P. L. Whitlow, I. Franco, R. E. Raymond, and E. J. Topol The importance of proteinuria as a determinant of mortality following percutaneous coronary revascularization in diabetics J. Am. Coll. Cardiol., April 1, 1999; 33(5): 1269 - 1277. [Abstract] [Full Text] [PDF]
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R. E. Kuntz Importance of Considering Atherosclerosis Progression When Choosing a Coronary Revascularization Strategy : The Diabetes–Percutaneous Transluminal Coronary Angioplasty Dilemma Circulation, February 23, 1999; 99(7): 847 - 851. [Full Text] [PDF]
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S. Elezi, A. Kastrati, J.u. Pache, A. Wehinger, M. Hadamitzky, J. Dirschinger, F.-J. Neumann, and A. Schomig Diabetes mellitus and the clinical and angiographic outcome after coronary stent placement J. Am. Coll. Cardiol., December 1, 1998; 32(7): 1866 - 1873. [Abstract] [Full Text] [PDF]
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A. Abizaid, R. Kornowski, G. S. Mintz, M. K. Hong, A. S. Abizaid, R. Mehran, A. D. Pichard, K. M. Kent, L. F. Satler, H. Wu, et al. The influence of diabetes mellitus on acute and late clinical outcomes following coronary stent implantation J. Am. Coll. Cardiol., September 1, 1998; 32(3): 584 - 589. [Abstract] [Full Text] [PDF]
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N. S. Kleiman, A. M. Lincoff, D. J. Kereiakes, D. P. Miller, F. V. Aguirre, K. M. Anderson, H. F. Weisman, R. M. Califf, and E. J. Topol Diabetes Mellitus, Glycoprotein IIb/IIIa Blockade, and Heparin : Evidence for a Complex Interaction in a Multicenter Trial Circulation, May 19, 1998; 97(19): 1912 - 1920. [Abstract] [Full Text] [PDF]
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G. W. Barsness, E. D. Peterson, E. M. Ohman, C. L. Nelson, E. R. DeLong, J. G. Reves, P. K. Smith, R. D. Anderson, R. H. Jones, D. B. Mark, et al. Relationship Between Diabetes Mellitus and Long-term Survival After Coronary Bypass and Angioplasty Circulation, October 21, 1997; 96(8): 2551 - 2556. [Abstract] [Full Text]
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K. E. Kip, E. L. Alderman, M. G. Bourassa, M. M. Brooks, L. Schwartz, D. R. Holmes Jr, R. M. Califf, P. L. Whitlow, B. R. Chaitman, and K. M. Detre Differential Influence of Diabetes Mellitus on Increased Jeopardized Myocardium After Initial Angioplasty or Bypass Surgery: Bypass Angioplasty Revascularization Investigation Circulation, April 23, 2002; 105(16): 1914 - 1920. [Abstract] [Full Text] [PDF]
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