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Modifiers of the Risk of Diabetes for Long-Term Outcomes After Coronary Revascularization: CREDO-Kyoto PCI/CABG
Kyohei Yamaji1, Hiroki Shiomi2, Takeshi Morimoto3
1Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
Insights
Diabetes significantly increases adverse cardiovascular and cerebral events after coronary revascularization, especially in younger patients. This highlights the need for more aggressive secondary prevention strategies in this high-risk group.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Interventional Cardiology
Background:
- Diabetes mellitus is a recognized risk factor for poor outcomes following coronary revascularization procedures.
- Identifying specific patient subgroups with diabetes who face disproportionately higher risks is crucial for targeted interventions.
Purpose of the Study:
- To pinpoint high-risk subgroups among diabetic patients undergoing coronary revascularization.
- To investigate whether the excess risk associated with diabetes is more pronounced in certain patient demographics.
Main Methods:
- Analysis of 39,427 patients from the CREDO-Kyoto PCI/CABG registry, comparing diabetic (n=15,561) and non-diabetic (n=23,866) individuals.
- Primary outcome: Major Adverse Cardiovascular and Cerebral Endpoints (MACCE), a composite of all-cause death, myocardial infarction, and stroke.
- Median follow-up of 5.6 years, with adjusted risk analyses stratified by age, sex, revascularization method, and acute myocardial infarction presentation.
Main Results:
- Diabetes was associated with significantly higher adjusted risks for MACCE.
- The excess risk of MACCE in diabetic patients increased with younger age, with the highest relative risk observed in those ≤64 years (aHR: 1.30).
- No significant interactions were found between diabetes and sex, mode of revascularization, or acute myocardial infarction presentation.
Conclusions:
- The heightened risk of MACCE associated with diabetes is particularly significant in younger patient populations.
- More intensive secondary prevention strategies may be warranted for younger patients with diabetes undergoing coronary revascularization.
Background:
Diabetes is a well-known risk factor for adverse outcomes after coronary revascularization.
Objectives:
This study sought to determine high-risk subgroups in whom the excess risks of diabetes relative to nondiabetes are particularly prominent and thus may benefit from more aggressive interventions.
Methods:
The study population consisted of 39,427 patients (diabetes: n = 15,561; nondiabetes: n = 23,866) who underwent first percutaneous coronary intervention (n = 33,144) or coronary artery bypass graft (n = 6,283) in the pooled CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Graft) registry. The primary outcome measure was major adverse cardiovascular and cerebral endpoints (MACCE), which was defined as a composite of all-cause death, myocardial infarction, and stroke.
Results:
With median follow-up of 5.6 years, diabetes was associated with significantly higher adjusted risks for MACCE. The excess adjusted risks of diabetes relative to nondiabetes for MACCE increased with younger age (≤64 years: adjusted HR: 1.30; 95% CI: 1.19-1.41; P < 0.001; 64-73 years: adjusted HR: 1.24; 95% CI: 1.16-1.33; P < 0.001; >73 years: adjusted HR: 1.17; 95% CI: 1.10-1.23; P < 0.001; P interaction < 0.001), mainly driven by greater excess adjusted mortality risk of diabetes relative to nondiabetes in younger tertile. No significant interaction was observed between adjusted risk of diabetes relative to nondiabetes for MACCE and other subgroups such as sex, mode of revascularization, and clinical presentation of acute myocardial infarction.
Conclusions:
The excess risk of diabetes relative to nondiabetes for MACCE was profound in the younger population. This observation suggests more aggressive interventions for secondary prevention in patients with diabetes might be particularly relevant in younger patients.
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