Impact of diabetes and early revascularization on the need for late and repeat procedures
Ady Orbach1, David A Halon1,2, Ronen Jaffe1,2
1Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal St., 3436212, Haifa, Israel.
Insights
Diabetes significantly increases the risk of repeat coronary revascularization, especially in insulin-treated patients, regardless of initial treatment. This highlights a key challenge in managing diabetic patients after coronary interventions.
Area of Science:
- Cardiology
- Diabetology
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) progression is accelerated in diabetic patients.
- The combined effect of diabetes and initial revascularization on late outcomes is not well understood.
Purpose of the Study:
- To investigate the impact of diabetes and early revascularization on the need for late or repeat revascularization.
- To assess the relationship between diabetic status, treatment intensity, and subsequent revascularization procedures.
Main Methods:
- Analysis of 12,420 patients undergoing coronary angiography (2000-2015).
- Categorization of patients based on early revascularization: none, percutaneous coronary intervention (PCI), or bypass surgery (CABG).
- Tracking of subsequent revascularization procedures over a median follow-up of 67 months.
Main Results:
- Late revascularization rates were 10% (none), 26% (PCI), and 11.1% (CABG).
- Diabetes significantly increased late revascularization risk: non-insulin treated (aHR 1.35) and insulin-treated (aHR 2.20).
- This association persisted across all early revascularization groups; repeat procedures were more common in diabetics, particularly those on insulin.
Conclusions:
- Diabetic status, especially insulin therapy, strongly predicts late or repeat revascularization, independent of initial treatment.
- High rates of repeat revascularization in diabetic patients post-PCI present a significant clinical challenge.
Background:
Coronary artery disease often progresses more rapidly in diabetics, but the integrated impact of diabetes and early revascularization status on late or repeat revascularization in the contemporary era is less clear.
Methods:
Coronary angiography was performed in 12,420 patients between the years 2000-2015 and early revascularization status [none, percutaneous coronary intervention (PCI) or bypass surgery (CABG)] was determined. Subsequent revascularization procedures were recorded over a median follow-up of 67 months and its relation to diabetic and baseline revascularization status was studied.
Results:
Early revascularization status was none in 5391, PCI in 5682 and CABG in 1347 patients. Late revascularization rates were 10, 26 and 11.1% respectively. Diabetes was present in 37%; a stepwise relationship of diabetic status with late revascularization was observed: no diabetes (reference) 14.4%, non-insulin treated diabetes 21% (adjusted HR 1.35, 95% CI 1.23-1.49, p < 0.001) and insulin-treated diabetes 32.8% (adjusted HR 2.20, 95% CI 1.91-2.54, p < 0.001), which was similar in magnitude for each early revascularization state (none, PCI or CABG). Further revascularizations (≥ 2) were also significantly more common in diabetics, in particular if insulin-treated. Glycosylated hemoglobin level was moderately associated with late revascularization in diabetics after early PCI but not following diagnostic catheterization or CABG.
Conclusions:
Diabetic status graded by treatment, and in particular insulin therapy, is a strong predictor for late or repeat revascularization irrespective of early revascularization status. The high rate of repeat revascularization in diabetics following PCI remains a challenging issue.
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