[Influence of diabetes mellitus on clinical outcome after percutaneous coronary revascularization]

Diabetes mellitus modifies the natural history of patients with coronary artery disease. The aim of this study was to assess the clinical outcome of diabetic patients with successful coronary angioplasty in our environment and to identify the factors predictive of complications during follow-up.

A retrospective analysis was made of a series of 198 diabetics and who underwent angioplasty from September 1996 to January 2000 in our hospital. A group of 198 nondiabetic patients who subsequently underwent the same procedure was used as the control group. Death, non-fatal myocardial infarction, unstable angina resulting in hospitalization and coronary revascularization were considered adverse events during a 1 year follow-up period.

The overall frequency of coronary adverse events in a 1-year follow-up was higher in diabetics (37%) than in non-diabetics (24%; p = 0.03). Diabetics had a less favorable clinical and angiographic profile and more frequent incomplete revascularization (43 vs 30%). Diabetics with incomplete revascularization were older (66.5 vs 53.2 years), had previous angioplasty more often, anatomically more unfavorable lesions (70 vs 51% type B2-C), and a smaller ejection fraction (54.7 vs 59.4%). Diabetics had more complications at 1 year of follow-up (37 vs 24%; p = 0.03), mainly due to increased cardiovascular mortality in diabetics with incomplete revascularization (12 vs 2%). Multivariate analysis identified incomplete revascularization as the only correlate of clinical outcome. Diabetes per se was not predictive of complications during follow-up.

Diabetics who undergo successful coronary revascularization have a less favorable clinical outcome than non-diabetic patients undergoing the same procedure at 1 year of follow up. Incomplete revascularization is associated with a less favorable outcome.