Abstract 2814: Temporal Changes in the Outcomes of Patients with Diabetes Mellitus Undergoing PCI in the NHLBI Dynamic Registry
Background: Previous studies have shown that patients with diabetes mellitus (DM) are at increased risk for adverse outcomes following PCI.
Methods: To determine whether outcomes have improved over time, we evaluated 2195 patients with DM in the NHLBI Dynamic Registry undergoing PCI in Waves 1 (‘97-‘98, insulin treated n=215, oral agent n=338), 2 (‘99, insulin n=193, oral agent n=312), 3 (‘01-‘02; insulin n=194, oral agent n=333), and 4 (‘04; insulin n=229, oral agent n=381). We compared baseline demographics and 1-year outcomes by recruitment wave and based on whether patients were treated with insulin or oral agents.
Results: In both insulin and oral agent treated patients with DM, there was a lower prevalence of prior MI in more recent cohorts while the prevalence of hypertension, and renal disease increased (p for trend<0.001 for each). In both groups, the lesion length increased significantly while the diameter stenosis decreased significantly in more recent cohorts. The percentage of patients with DM discharged on ace inhibitors, beta blockers and statins increased significantly over time (p-value for trend for each <0.001). The cumulative one year major adverse coronary event (MACE) rate, a composite of death, MI and repeat revascularization, in patients with DM treated with insulin by chronological Wave were 34.6%, 34.9%, 32.0%, and 29.1%, respectively, (p-value for trend=0.37). MACE rates in oral agent treated patients by chronological Wave were 33.1%, 28.2%, 25.5%, and 20.6%, respectively, (p-value for trend=0.0001). The adjusted hazard ratio of MACE in insulin treated patients with DM in waves 2, 3, and 4 as compared to wave 1 were similar. In contrast, the adjusted hazard ratio for oral agent treated patients with DM for Wave 3 compared to wave 1 was 0.70 (95% CI 0.51– 0.96, p=0.03) and for wave 4 compared to wave 1 was 0.53 (95% CI 0.39 – 0.72, p<0.001).
Conclusions: Patients with diabetes treated with oral agents in the Dynamic Registry demonstrated a significant decrease in 1-year adverse events following PCI over time. In insulin-treated diabetic patients, however, outcomes following PCI have not significantly improved. The implications of this finding and the potential impact of peri-procedural glucose control will require further study.