Long-term outcome of coronary balloon angioplasty in diabetic patients
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T Przewłocki1, P Pieniazek, W Ryniewicz
1Department of Cardiac and Vascular Diseases, Institute of Cardiology, Collegium Medicum, Jagiellonian University, Ul. Pradnicka 80, 31-202, Cracow, Poland.
Insights
Diabetic patients undergoing coronary angioplasty experienced higher restenosis and re-intervention rates. However, long-term mortality and myocardial infarction rates were similar to non-diabetics, indicating angioplasty is a safe procedure for diabetics.
Area of Science:
- Cardiology
- Diabetology
- Interventional Cardiology
Background:
- Diabetes mellitus is a known risk factor for increased morbidity and mortality post-coronary revascularization.
- Understanding long-term outcomes after angioplasty in diabetic patients is crucial for risk stratification and management.
Purpose of the Study:
- To compare the clinical outcomes of coronary balloon angioplasty in diabetic versus non-diabetic patients over a mean 5-year follow-up period.
Main Methods:
- A retrospective study of 621 patients undergoing elective angioplasty between 1987 and 1996.
- Comparison of clinical and angiographic characteristics, procedural success, complications, and long-term outcomes (restenosis, re-intervention, mortality, myocardial infarction, CCS status) between 60 diabetic and 561 non-diabetic patients.
Main Results:
- Diabetic patients had higher rates of restenosis (46.3% vs. 32.2%) and re-intervention (50.0% vs. 35.4%), and were more often referred for coronary artery bypass grafting (CABG) (20.4% vs. 9.9%).
- Despite these differences, there were no significant variations in mortality (1.9% vs. 2.8%) or myocardial infarction (3.7% vs. 4.4%) between the groups.
- Diabetic patients exhibited worse Canadian Cardiovascular Society (CCS) functional status at follow-up (61.1% vs. 74.4% in Class 0/I).
Conclusions:
- Coronary balloon angioplasty is a safe procedure in diabetic patients, with comparable long-term mortality and myocardial infarction rates to non-diabetics.
- Diabetics face increased risks of restenosis and re-intervention after angioplasty, necessitating careful consideration of alternative or adjunctive therapies.
Abstract:
Diabetes is recognised to increase morbidity and mortality after coronary revascularization. We compared clinical outcomes in mean 5-year-long follow-up of coronary balloon angioplasty in diabetic and non-diabetic patients. We studied 621 patients undergoing elective angioplasty from 1987 to 1996. There were 60 (9.7%) patients with diabetes who were compared with 561 non-diabetic patients. Diabetics were older, more often obese, less frequently were current smokers, and less frequently had hypercholesterolaemia. Diabetic patients in comparison with non-diabetics had lower ejection fraction and more frequently had angioplasty of complex (B2 or C) lesions, but there were no differences between both groups in the other clinical and angiographic risk factors. Clinical success of angioplasty, as well as complications rate were similar in both groups. In follow-up restenosis occurred more frequently in diabetics (46.3 vs. 32.2%, P=0.03), resulting in significantly higher re-intervention rate (50.0 vs. 35.4%, P=0.03). Especially diabetic patients were more frequently referred to CABG (20.4 vs. 9. 9%, P=0.02). There were no significant differences in deaths (1.9 vs. 2.8%) and myocardial infarction (3.7 vs. 4.4%). Diabetics presented worse CCS status at the end of observation (Class 0 and I - 61.1 vs. 74.4%, P=0.037). Angioplasty proved to be a safe procedure in diabetic patients. Despite higher restenosis and re-intervention rate in diabetics, mortality as well as myocardial infarction rate was the same in both groups during mean 5-year follow-up.
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