Abstract 18851: Effect of Diabetes Mellitus Treatment Type in Patients Undergoing Percutaneous Coronary Intervention
Background: Patients with type 2 diabetes mellitus have a higher risk of cardiovascular events than those without diabetes. The effect of specific oral treatment type for diabetes on cardiovascular events remains unclear. Objective: The goal of this study is to investigate baseline risk factors, angiographic characteristics, interventional procedural information, and hospital outcomes in non-diabetic and diabetic patients who undergo percutaneous coronary intervention (PCI). Diabetic patients were divided into insulin treated diabetics and oral medication treated patients. Oral medication treated patients were subdivided according to oral medication drug class.
Methods: We performed a retrospective analysis of 1,381 patients treated with PCI at the Los Angeles County Hospital + USC Medical Center and Keck Medical Center of USC between January 2008 and June 2011. Patients were divided into two groups: non-diabetic (ND, n= 645) and type-2 diabetes mellitus (DM, n= 704). Diabetic patients were further divided into those treated with insulin (IDM, n= 414) or oral medication (ODM, n= 290). Additional comparisons of ODM patients according to medication class were performed between sulphonyurea, biguanide and thiazolidinediones.
Results: IDM patients were more likely than ODM patients to present with an acute coronary syndrome (56.2% vs. 43.8%) and suffer in hospital mortality (1.01% vs. 0%, p=0.03). Acute renal failure (6.10% vs. 1.99% vs. 1.37%, p<0.000), intra-aortic balloon pump-IABP (12.53% vs. 6.01% vs. 6.27%, p=0.0008), and MACE (13.77% vs. 8.39% vs. 8.99%, p=0.02) rates were higher in IDM than ODM and ND. Among ODM, biguanide treated patients compared to sulphonylurea and thiazolidinediones were more likely to present with an ACS (77.3% vs. 19.3% vs. 3.4%). There were no differences between groups on infract size and post-procedure success rate or TIMI flow.
Conclusion: Insulin and biguanide treated diabetic patients are more likely to present with an acute coronary syndromes than non-diabetic and other orally treated diabetic patients. The outcome of insulin treated diabetic patients after PCI is worse than any other group with higher mortality, renal failure, IABP use and MACE.
- © 2012 by American Heart Association, Inc.