Abstract 12187: Synergistic Impact of Diabetes Mellitus and Prior Myocardial Infarction on the Incidence of Cardiovascular Mortality in Patients after Coronary Revascularization in the Drug-eluting Stent Era

Abstract

Background: Comparably high cardiovascular risk has been shown in patients with diabetic (DM) patients but without prior myocardial infarction (MI) and in non-diabetic patients with prior MI. However, significance of DM as a cardiovascular risk factor relative to prior MI has not been fully studied in the drug-eluting-stent era. Purpose: To evaluate the impact of DM and prior MI on cardiovascular mortality in the drug-eluting stent era.

Methods: During 2005-7, 15939 patients undergoing their first PCI or CABG at 26 hospitals in Japan were enrolled in CREDO-Kyoto PCI/CABG registry cohort-2. This study was comprised of 10363 patients: 5097 non-diabetic patients without prior MI (DM-/MI-), 888 non-diabetic patients with prior MI (DM-/MI+), 3607 diabetic patients without prior MI (DM+/MI-) and 771 diabetic patients with prior MI (DM+/MI+). Patients with acute MI were not included. The main outcome measure was cardiovascular death.

Results: The cumulative incidence of cardiovascular death at 3 years were 3.6% (reference) in DM-/MI-, 6.3% (log rank p<0.001) in DM-/MI+, 5.6% (p<0.001) in DM+/MI-, and 21.7% (p<0.001) in DM+/MI+, respectively. Multivariate Cox proportional hazard models using DM-/MI- as a reference revealed that DM-/MI+, DM+/MI- and DM+/MI+ were significantly associated with increased risks for cardiovascular death (DM-/MI+: hazard ratio (HR)=1.60, 95% confidence interval (CI)=1.16-2.18, p<0.001; DM+/MI-: HR=1.47, 95% CI=1.17-1.54, p= p<0.001; DM+/MI+: HR=2.02, 95% CI=1.50-2.71, p<0.001). The adjusted risk for cardiovascular death in DM-/MI+ was not significantly different from DM+/MI- (HR=1.10, 95% C.I. 0.81-1.50, p=0.55). DM+/MI+ had a significantly higher risk for cardiovascular death than DM-/MI+ and DM+/MI- (vs. DM+/MI-: HR=1.38, 95% CI=1.04-1.83, p=0.026; vs. DM-/MI+: HR=1.38, 95%CI=1.03-1.82, p=0.028).

Conclusions: In the drug-eluting-stent era, individual impact of DM and prior MI on the cardiovascular mortality risk was comparable in patients undergoing their first coronary revascularization. A combination of DM and prior MI resulted in remarkably high incidence of cardiovascular mortality.