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Differential Impact of Type 1 and Type 2 Diabetes Mellitus on Outcomes Among 1.4 Million US Patients Undergoing
Andrija Matetic1, Gemina Doolub2, Aditya Bharadwaj3
1Department of Cardiology, University Hospital of Split, Split, Croatia; Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, UK.
Insights
Patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI) face higher risks of adverse outcomes. Type 1 DM patients represent a particularly high-risk group post-PCI.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Diabetes mellitus (DM) is a growing concern globally.
- Percutaneous coronary intervention (PCI) is a common procedure for coronary artery disease.
- Limited data exists on DM's impact on PCI outcomes, especially concerning DM subtypes.
Purpose of the Study:
- To determine the impact of diabetes mellitus (DM) and its subtypes on in-hospital outcomes following percutaneous coronary intervention (PCI).
- To compare adverse events in patients with type 1 DM (T1DM) and type 2 DM (T2DM) versus those without DM undergoing PCI.
Main Methods:
- Analysis of National Inpatient Sample data from October 2015 to December 2018.
- Stratification of PCI hospitalizations based on the presence and subtype of DM.
- Multivariable logistic regression to calculate adjusted odds ratios (aOR) for in-hospital adverse outcomes.
Main Results:
- T1DM patients showed significantly higher adjusted odds ratios (aOR) for major adverse cardiovascular and cerebrovascular events (MACCE), mortality, major bleeding, and stroke compared to no-DM.
- T2DM patients had increased aOR for MACCE, mortality, and stroke, but not major bleeding.
- Both T1DM and T2DM patients had lower aOR for cardiac complications compared to no-DM patients.
Conclusions:
- Diabetes mellitus significantly increases the likelihood of adverse in-hospital outcomes after PCI.
- Type 1 DM patients constitute a particularly high-risk cohort requiring closer monitoring and management post-PCI.
Background:
The aim was to determine the impact of diabetes mellitus (DM) on outcomes after percutaneous coronary intervention (PCI). There is limited data on the impact of DM and its subtypes among patients who underwent PCI during hospitalization.
Methods:
All PCI hospitalizations from the National Inpatient Sample (October 2015-December 2018) were stratified by the presence and subtype of DM. Multivariable logistic regression was performed to determine the adjusted odds ratios (aOR) of in-hospital adverse outcomes in type 1 DM (T1DM) and type 2 DM (T2DM) compared to no-DM.
Results:
Out of 1,363,800 individuals undergoing PCI, 12,640 (0.9%) had T1DM and 539,690 (39.6%) had T2DM. T1DM patients had increased aOR of major adverse cardiovascular and cerebrovascular events (MACCE) (1.26, 95%CI 1.17-1.35), mortality (1.56, 95%CI 1.41-1.72), major bleeding (1.63, 95%CI 1.45-1.84), and stroke (1.75, 95%CI 1.51-2.02), while T2DM patients had only increased aOR of MACCE (1.02, 95%CI 1.01-1.04), mortality (1.10, 95%CI 1.08-1.13) and stroke (1.22, 95%CI 1.18-1.27), compared to no-DM patients. However, both T1DM and T2DM had lower aOR of cardiac complications (0.87, 95%CI 0.77-0.97 and 0.87, 95%CI 0.85-0.89, respectively), in comparison to no-DM patients. When accounting for the indication, both DM subgroups had higher aOR of MACCE, mortality, and stroke compared to no-DM patients in the acute coronary syndrome setting (p < 0.001, for all), while only increased aOR of stroke (1.59, 95%CI 1.17-2.15 for T1DM and 1.12, 95%CI 1.05-1.20 for T2DM) persisted in the elective setting.
Conclusions:
Patients with DM who have undergone PCI during hospitalization are more likely to experience adverse in-hospital outcomes, and T1DM patients are a particularly high-risk cohort.
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