(Circulation. 1995;91:979-989.)
© 1995 American Heart Association, Inc.
Articles |
Influence of Diabetes Mellitus on Early and Late Outcome After Percutaneous Transluminal Coronary Angioplasty
Presented in part at the American College of Cardiology 41st Annual Scientific Session, Dallas, Tex, April 12-16, 1992.
From the Center For Cardiovascular Epidemiology and the Andreas Gruentzig Cardiovascular Center, Divisions of Cardiology and Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, Ga.
Correspondence to William S. Weintraub, MD, Division of Cardiology, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA 30322.
Background Although patients with diabetes mellitus constitute an important segment of the population undergoing coronary angioplasty, the outcome of these patients has not been well characterized.
Methods and Results Data for 1133 diabetic and 9300 nondiabetic patients undergoing elective angioplasty from 1980 to 1990 were analyzed. Diabetics were older and had more cardiovascular comorbidity. Insulin-requiring (IR) diabetics had diabetes for a longer duration and worse renal and ventricular functions compared with non-IR subjects. Angiographic and clinical successes after angioplasty were high and similar in diabetics and nondiabetics. In-hospital major complications were infrequent (3%), with a trend toward higher death or myocardial infarction in IR diabetics. Five-year survival (89% versus 93%) and freedom from infarction (81% versus 89%) were lower, and bypass surgery and additional angioplasty were required more often in diabetics. In diabetics, only 36% survived free of infarction or additional revascularization compared with 53% of nondiabetics, with a marked attrition in the first year after angioplasty, when restenosis is most common. Multivariate correlates of decreased 5-year survival were older age, reduced ejection fraction, history of heart failure, multivessel disease, and diabetes. IR diabetics had worse long-term survival and infarction-free survival than non-IR diabetics.
Conclusions Coronary angioplasty in diabetics is associated with high success and low complication rates. Although long-term survival is acceptable, diabetics have a higher rate of infarction and a greater need for additional revascularization procedures, probably because of early restenosis and late progression of coronary disease. The most appropriate treatment for these patients remains to be determined.
Key Words: diabetes mellitus • insulin • angioplasty
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P. Theroux, J. Alexander Jr, C. Pharand, E. Barr, S. Snapinn, A. F. Ghannam, and F. L. Sax Glycoprotein IIb/IIIa Receptor Blockade Improves Outcomes in Diabetic Patients Presenting With Unstable Angina/Non-ST-Elevation Myocardial Infarction : Results From the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study Circulation, November 14, 2000; 102(20): 2466 - 2472. [Abstract] [Full Text] [PDF]
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Y Otsuka, S Miyazaki, H Okumura, S Yasuda, S Daikoku, I Morii, Y Sutani, Y Goto, and H Nonogi Abnormal glucose tolerance, not small vessel diameter, is a determinant of long-term prognosis in patients treated with balloon coronary angioplasty Eur. Heart J., November 1, 2000; 21(21): 1790 - 1796. [Abstract] [PDF]
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J. M. Ahmed, M. K. Hong, R. Mehran, G. Dangas, G. S. Mintz, A. D. Pichard, L. F. Satler, K. M. Kent, H. Wu, G. W. Stone, et al. Influence of diabetes mellitus on early and late clinical outcomes in saphenous vein graft stenting J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1186 - 1193. [Abstract] [Full Text] [PDF]
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E. Braunwald, E. M. Antman, J. W. Beasley, R. M. Califf, M. D. Cheitlin, J. S. Hochman, R. H. Jones, D. Kereiakes, J. Kupersmith, T. N. Levin, et al. ACC/AHA guidelines for the management of patients with unstable angina and non-st-segment elevation myocardial infarction: A report of the american college of cardiology/ american heart association task force on practice guidelines (committee on the management of patients with unstable angina) J. Am. Coll. Cardiol., September 1, 2000; 36(3): 970 - 1062. [Full Text] [PDF]
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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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A. Chajara, M. Raoudi, B. Delpech, M. Leroy, J. P. Basuyau, and H. Levesque Increased Hyaluronan and Hyaluronidase Production and Hyaluronan Degradation in Injured Aorta of Insulin-Resistant Rats Arterioscler Thromb Vasc Biol, June 1, 2000; 20(6): 1480 - 1487. [Abstract] [Full Text] [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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S. B. King III Acute myocardial infarction: are diabetics different? J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1513 - 1515. [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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D. L. Bhatt, S. P. Marso, A. M. Lincoff, K. E. Wolski, S. G. Ellis, and E. J. Topol Abciximab reduces mortality in diabetics following percutaneous coronary intervention J. Am. Coll. Cardiol., March 15, 2000; 35(4): 922 - 928. [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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A. S. Abizaid, G. S. Mintz, A. Abizaid, R. Mehran, A. J. Lansky, A. D. Pichard, L. F. Satler, H. Wu, K. M. Kent, and M. B. Leon One-year follow-up after intravascular ultrasound assessment of moderate left main coronary artery disease in patients with ambiguous angiograms J. Am. Coll. Cardiol., September 1, 1999; 34(3): 707 - 715. [Abstract] [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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A. S. Abizaid, G. S. Mintz, R. Mehran, A. Abizaid, A. J. Lansky, A. D. Pichard, L. F. Satler, H. Wu, C. Pappas, K. M. Kent, et al. Long-Term Follow-Up After Percutaneous Transluminal Coronary Angioplasty Was Not Performed Based on Intravascular Ultrasound Findings : Importance of Lumen Dimensions Circulation, July 20, 1999; 100(3): 256 - 261. [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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K. Yasunari, M. Kohno, H. Kano, K. Yokokawa, M. Minami, and J. Yoshikawa Antioxidants Improve Impaired Insulin-Mediated Glucose Uptake and Prevent Migration and Proliferation of Cultured Rabbit Coronary Smooth Muscle Cells Induced by High Glucose Circulation, March 16, 1999; 99(10): 1370 - 1378. [Abstract] [Full Text] [PDF]
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R. N. Piana, W. H. Ahmed, B. Chaitman, P. Ganz, S. Kinlay, J. Strony, B. Adelman, J. A. Bittl, and on behalf of the Hirulog Angioplasty Study Investi Effect of transient abrupt vessel closure during otherwise successful angioplasty for unstable angina on clinical outcome at six months J. Am. Coll. Cardiol., January 1, 1999; 33(1): 73 - 78. [Abstract] [Full Text] [PDF]
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K. N. Garratt, P. A. Brady, N. L. Hassinger, D. E. Grill, A. Terzic, and D. R. Holmes Jr. Sulfonylurea drugs increase early mortality in patients with diabetes mellitus after direct angioplasty for acute myocardial infarction J. Am. Coll. Cardiol., January 1, 1999; 33(1): 119 - 124. [Abstract] [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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Y. Nishimoto, Y. Miyazaki, Y. Toki, R. Murakami, M. Shinoda, A. Fukushima, and H. Kanayama Enhanced secretion of insulin plays a role in the development of atherosclerosis and restenosis of coronary arteries: elective percutaneous transluminal coronary angioplasty in patients with effort angina J. Am. Coll. Cardiol., November 15, 1998; 32(6): 1624 - 1629. [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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J. W SAYER and A. D TIMMIS Investigation of coronary artery disease in diabetes: is screening of asymptomatic patients necessary? Heart, December 1, 1997; 78(6): 525 - 526. [Full Text] [PDF]
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D. J. Schneider, P. M. Absher, and M. A. Ricci Dependence of Augmentation of Arterial Endothelial Cell Expression of Plasminogen Activator Inhibitor Type 1 by Insulin on Soluble Factors Released From Vascular Smooth Muscle Cells Circulation, November 4, 1997; 96(9): 2868 - 2876. [Abstract] [Full Text]
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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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S. B. King III Is It Important How One Dies? : Questions for Planning Future Revascularization Trials Circulation, October 7, 1997; 96(7): 2121 - 2123. [Full Text]
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