Advertisement

Effect of Diabetes Mellitus on Frequency of Adverse Events in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention

      Few data are available on the timing of adverse events in relation to the status of diabetes mellitus and the type of acute coronary syndrome (ACS). We investigated this issue in diabetic and nondiabetic patients admitted with a diagnosis of non–ST-segment elevation ACS (NSTE-ACS) or ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention. Patient-level data from 6 studies (n = 16,601) were pooled and only patients with ACS are included (n = 9,492). Early (0 to 30 days), late (31 to 365 days), and overall (0 to 365 days) events were analyzed. Diabetes mellitus was present in 1,927 patients (20.3%). At 1 year, all-cause mortality was highest for diabetic patients with STEMI (13.4%), followed by diabetic patients with NSTE-ACS (10.3%), nondiabetic patients with STEMI (6.4%) and nondiabetic patients with NSTE-ACS (4.4%; p <0.001). Among patients with diabetes, there was a significant interaction (p <0.001) for STEMI versus NSTE-ACS in early compared with late mortality, due to an excess of early mortality associated with STEMI (9.3% vs 3.7%; hazard ratio 2.31, 95% CI 1.52 to 3.54, p <0.001). Compared with diabetic NSTE-ACS patients, diabetic patients with STEMI had an increased risk of early stent thrombosis (hazard ratio 2.26, 95% CI 1.48 to 3.44, p <0.001), as well as a significant interaction (p = 0.009) in the risk of target lesion revascularization between the early and late follow-up. The distribution of fatal and nonfatal events according to the type of ACS was not influenced by diabetic status. In conclusion, diabetes in ACS setting confers a worse prognosis with 1-year mortality >10% in both STEMI and NSTE-ACS. Notwithstanding the high absolute rates, the temporal distribution of adverse events related to the type of ACS is similar between diabetic and nondiabetic patients.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ndrepepa G.
        • Kastrati A.
        Bleeding complications in patients undergoing percutaneous coronary interventions: current status and perspective.
        Coron Artery Dis. 2014; 25: 247-257
        • Gregg E.W.
        • Li Y.
        • Wang J.
        • Burrows N.R.
        • Ali M.K.
        • Rolka D.
        • Williams D.E.
        • Geiss L.
        Changes in diabetes-related complications in the United States, 1990-2010.
        N Engl J Med. 2014; 370: 1514-1523
        • Chan M.Y.
        • Sun J.L.
        • Newby L.K.
        • Shaw L.K.
        • Lin M.
        • Peterson E.D.
        • Califf R.M.
        • Kong D.F.
        • Roe M.T.
        Long-term mortality of patients undergoing cardiac catheterization for ST-elevation and non-ST-elevation myocardial infarction.
        Circulation. 2009; 119: 3110-3117
        • Park H.W.
        • Yoon C.H.
        • Kang S.H.
        • Choi D.J.
        • Kim H.S.
        • Cho M.C.
        • Kim Y.J.
        • Chae S.C.
        • Yoon J.H.
        • Gwon H.C.
        • Ahn Y.K.
        • Jeong M.H.
        • KAMIR/KorMI Registry
        Early- and late-term clinical outcome and their predictors in patients with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction.
        Int J Cardiol. 2013; 169: 254-261
        • Savonitto S.
        • Ardissino D.
        • Granger C.B.
        • Morando G.
        • Prando M.D.
        • Mafrici A.
        • Cavallini C.
        • Melandri G.
        • Thompson T.D.
        • Vahanian A.
        • Ohman E.M.
        • Califf R.M.
        • Van de Werf F.
        • Topol E.J.
        Prognostic value of the admission electrocardiogram in acute coronary syndromes.
        JAMA. 1999; 281: 707-713
        • Donahoe S.M.
        • Stewart G.C.
        • McCabe C.H.
        • Mohanavelu S.
        • Murphy S.A.
        • Cannon C.P.
        • Antman E.M.
        Diabetes and mortality following acute coronary syndromes.
        JAMA. 2007; 298: 765-775
        • Franklin K.
        • Goldberg R.J.
        • Spencer F.
        • Klein W.
        • Budaj A.
        • Brieger D.
        • Marre M.
        • Steg P.G.
        • Gowda N.
        • Gore J.M.
        • GRACE Investigators
        Implications of diabetes in patients with acute coronary syndromes. The Global Registry of Acute Coronary Events.
        Arch Intern Med. 2004; 164: 1457-1463
        • Malmberg K.
        • Yusuf S.
        • Gerstein H.C.
        • Brown J.
        • Zhao F.
        • Hunt D.
        • Piegas L.
        • Calvin J.
        • Keltai M.
        • Budaj A.
        Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction: results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) registry.
        Circulation. 2000; 102: 1014-1019
        • Piccolo R.
        • Galasso G.
        • Iversen A.Z.
        • Eitel I.
        • Dominguez-Rodriguez A.
        • Gu Y.L.
        • de Smet B.J.
        • Mahmoud K.D.
        • Abreu-Gonzalez P.
        • Trimarco B.
        • Thiele H.
        • Piscione F.
        Effects of baseline coronary occlusion and diabetes mellitus in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
        Am J Cardiol. 2014; 114: 1145-1150
        • Franzone A.
        • Pilgrim T.
        • Heg D.
        • Roffi M.
        • Tuller D.
        • Vuilliomenet A.
        • Muller O.
        • Cook S.
        • Weilenmann D.
        • Kaiser C.
        • Jamshidi P.
        • Raber L.
        • Stortecky S.
        • Wenaweser P.
        • Juni P.
        • Windecker S.
        Clinical outcomes according to diabetic status in patients treated with biodegradable polymer sirolimus-eluting stents versus durable polymer everolimus-eluting stents: prespecified subgroup analysis of the BIOSCIENCE trial.
        Circ Cardiovasc Interv. 2015; 8: e002319
        • Windecker S.
        • Remondino A.
        • Eberli F.R.
        • Juni P.
        • Raber L.
        • Wenaweser P.
        • Togni M.
        • Billinger M.
        • Tuller D.
        • Seiler C.
        • Roffi M.
        • Corti R.
        • Sutsch G.
        • Maier W.
        • Luscher T.
        • Hess O.M.
        • Egger M.
        • Meier B.
        Sirolimus-eluting and paclitaxel-eluting stents for coronary revascularization.
        N Engl J Med. 2005; 353: 653-662
        • Windecker S.
        • Serruys P.W.
        • Wandel S.
        • Buszman P.
        • Trznadel S.
        • Linke A.
        • Lenk K.
        • Ischinger T.
        • Klauss V.
        • Eberli F.
        • Corti R.
        • Wijns W.
        • Morice M.C.
        • di Mario C.
        • Davies S.
        • van Geuns R.J.
        • Eerdmans P.
        • van Es G.A.
        • Meier B.
        • Juni P.
        Biolimus-eluting stent with biodegradable polymer versus sirolimus-eluting stent with durable polymer for coronary revascularisation (LEADERS): a randomised non-inferiority trial.
        Lancet. 2008; 372: 1163-1173
        • Serruys P.W.
        • Silber S.
        • Garg S.
        • van Geuns R.J.
        • Richardt G.
        • Buszman P.E.
        • Kelbaek H.
        • van Boven A.J.
        • Hofma S.H.
        • Linke A.
        • Klauss V.
        • Wijns W.
        • Macaya C.
        • Garot P.
        • DiMario C.
        • Manoharan G.
        • Kornowski R.
        • Ischinger T.
        • Bartorelli A.
        • Ronden J.
        • Bressers M.
        • Gobbens P.
        • Negoita M.
        • van Leeuwen F.
        • Windecker S.
        Comparison of zotarolimus-eluting and everolimus-eluting coronary stents.
        N Engl J Med. 2010; 363: 136-146
        • Zbinden R.
        • Piccolo R.
        • Heg D.
        • Roffi M.
        • Kurz D.J.
        • Muller O.
        • Vuilliomenet A.
        • Cook S.
        • Weilenmann D.
        • Kaiser C.
        • Jamshidi P.
        • Franzone A.
        • Eberli F.
        • Juni P.
        • Windecker S.
        • Pilgrim T.
        Ultrathin strut biodegradable polymer sirolimus-eluting stent versus durable-polymer everolimus-eluting stent for percutaneous coronary revascularization: 2-Year results of the BIOSCIENCE trial.
        J Am Heart Assoc. 2016; 5: e003255
        • Valgimigli M.
        • Campo G.
        • Monti M.
        • Vranckx P.
        • Percoco G.
        • Tumscitz C.
        • Castriota F.
        • Colombo F.
        • Tebaldi M.
        • Fuca G.
        • Kubbajeh M.
        • Cangiano E.
        • Minarelli M.
        • Scalone A.
        • Cavazza C.
        • Frangione A.
        • Borghesi M.
        • Marchesini J.
        • Parrinello G.
        • Ferrari R.
        • Prolonging Dual Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia Study (PRODIGY) Investigators
        Short- versus long-term duration of dual-antiplatelet therapy after coronary stenting: a randomized multicenter trial.
        Circulation. 2012; 125: 2015-2026
        • Pilgrim T.
        • Heg D.
        • Roffi M.
        • Tuller D.
        • Muller O.
        • Vuilliomenet A.
        • Cook S.
        • Weilenmann D.
        • Kaiser C.
        • Jamshidi P.
        • Fahrni T.
        • Moschovitis A.
        • Noble S.
        • Eberli F.R.
        • Wenaweser P.
        • Juni P.
        • Windecker S.
        Ultrathin strut biodegradable polymer sirolimus-eluting stent versus durable polymer everolimus-eluting stent for percutaneous coronary revascularisation (BIOSCIENCE): a randomised, single-blind, non-inferiority trial.
        Lancet. 2014; 384: 2111-2122
        • Vranckx P.
        • Cutlip D.E.
        • Mehran R.
        • Kint P.P.
        • Silber S.
        • Windecker S.
        • Serruys P.W.
        Myocardial infarction adjudication in contemporary all-comer stent trials: balancing sensitivity and specificity. Addendum to the historical MI definitions used in stent studies.
        EuroIntervention. 2010; 5: 871-874
        • Cutlip D.E.
        • Windecker S.
        • Mehran R.
        • Boam A.
        • Cohen D.J.
        • van Es G.A.
        • Steg P.G.
        • Morel M.A.
        • Mauri L.
        • Vranckx P.
        • McFadden E.
        • Lansky A.
        • Hamon M.
        • Krucoff M.W.
        • Serruys P.W.
        • Academic Research C.
        Clinical end points in coronary stent trials: a case for standardized definitions.
        Circulation. 2007; 115: 2344-2351
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Lambert P.C.
        • Royston P.
        Further development of flexible parametric models for survival analysis.
        Stata J. 2009; 9: 265-290
        • Roffi M.
        • Angiolillo D.J.
        • Kappetein A.P.
        Current concepts on coronary revascularization in diabetic patients.
        Eur Heart J. 2011; 32: 2748-2757
        • Armstrong E.J.
        • Rutledge J.C.
        • Rogers J.H.
        Coronary artery revascularization in patients with diabetes mellitus.
        Circulation. 2013; 128: 1675-1685
        • Piccolo R.
        • Eitel I.
        • Galasso G.
        • Iversen A.Z.
        • Gu Y.L.
        • Dominguez-Rodriguez A.
        • de Smet B.J.
        • Mahmoud K.D.
        • Abreu-Gonzalez P.
        • Thiele H.
        • Piscione F.
        Intracoronary abciximab in diabetic patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
        Vascul Pharmacol. 2015; 73: 32-37
        • Piccolo R.
        • Di Gioia G.
        • Niglio T.
        • D'Anna C.
        • De Rosa R.
        • Strisciuglio T.
        • Bevilacqua M.
        • Piscione F.
        • Cirillo P.
        • Galasso G.
        Pharmacotherapeutic considerations for the use of prasugrel and ticagrelor to reduce stent thrombosis in patients with acute coronary syndrome.
        Angiology. 2014; 65: 130-136
        • Piccolo R.
        • Windecker S.
        Dual antiplatelet therapy in percutaneous coronary intervention: a tale of 2 decades with new perspectives in the era of new-generation drug-eluting stents.
        Circ Cardiovasc Interv. 2016; 9: e003587