Patterns and Outcomes of Completeness of Revascularization in Patients With Diabetes and Non-ST-Segment-Elevation
Lucas C Godoy1,2, Michael E Farkouh3, Peter C Austin2,4
1Division of Cardiology, University of Ottawa Heart Institute, Faculty of Medicine, University of Ottawa, Ontario, Canada (L.C.G.).
Insights
Revascularization strategies for diabetes patients with non-ST-elevation myocardial infarction significantly impact survival. Coronary artery bypass grafting and complete PCI reduce mortality compared to incomplete PCI or no revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diabetes Management
Background:
- Non-ST-segment-elevation myocardial infarction (NSTEMI) in diabetic patients presents unique challenges.
- Optimal revascularization strategies for this population remain incompletely defined.
- Understanding practice patterns and outcomes is crucial for improving patient care.
Purpose of the Study:
- To investigate revascularization rates in patients with diabetes and NSTEMI.
- To evaluate the association between completeness of revascularization and clinical outcomes.
- To identify differences in practice patterns across revascularization strategies.
Main Methods:
- Retrospective cohort study of 14,511 patients with diabetes and NSTEMI in Ontario, Canada (2009-2020).
- Patients were categorized into four groups: coronary artery bypass grafting (CABG), complete percutaneous coronary intervention (PCI), incomplete PCI, and no revascularization.
- Cox regression analysis was used to compare 5-year all-cause mortality, adjusted for baseline characteristics.
Main Results:
- A significant proportion (23.1%) of patients did not receive any revascularization.
- Five-year all-cause mortality rates were 25.9% (CABG), 29.8% (complete PCI), 32.2% (incomplete PCI), and 39.4% (no revascularization).
- Compared to no revascularization, CABG, complete PCI, and incomplete PCI were associated with significant reductions in mortality (46%, 35%, and 27% respectively).
Conclusions:
- Nearly a quarter of diabetic patients with NSTEMI did not undergo revascularization.
- Both CABG and complete PCI demonstrated superior survival benefits compared to incomplete PCI or no revascularization.
- These findings highlight the importance of comprehensive revascularization strategies in managing diabetic patients with NSTEMI.
Background:
It remains unknown how often, and to which extent, patients with diabetes and non-ST-segment-elevation myocardial infarction are revascularized. This study aimed to identify practice patterns and clinical outcomes in patients with diabetes and non-ST-segment-elevation myocardial infarction according to completeness of revascularization.
Methods:
All patients with diabetes and multivessel disease hospitalized for non-ST-segment-elevation myocardial infarction in Ontario, Canada, between April 2009 and March 2020 and undergoing coronary angiography were included. Patients with previous coronary artery bypass grafting (CABG) at any time, percutaneous coronary intervention (PCI) in the previous 90 days, or an ST-segment-elevation myocardial infarction in the previous 90 days were excluded, as were patients with hemodynamic instability at hospital admission. Patients were classified into 4 groups, from the most to the least complete revascularization strategy: CABG, complete revascularization with PCI, incomplete PCI, or no revascularization. The primary outcome was all-cause death at 5 years. Cox regression adjusted for multiple baseline characteristics was used to compare outcomes between groups.
Results:
We included 14 511 patients (mean age: 68.7±11.5 years; 69.6% male patients); 4525 (31.2%) were treated with CABG, 3008 (20.7%) with complete PCI, 3624 (25.0%) with incomplete PCI, and 3354 (23.1%) did not receive any revascularization procedure. Adjusted 5-year risks of all-cause death after CABG, complete PCI, incomplete PCI, and no revascularization were progressively increased: 25.9%, 29.8%, 32.2%, and 39.4% respectively. Compared with no revascularization, a 46% reduction in all-cause death was observed after CABG (hazard ratio, 0.54 [95% CI, 0.50-0.58]), 35% after complete PCI (hazard ratio, 0.65 [95% CI, 0.60-0.71]), and 27% after incomplete PCI (hazard ratio, 0.73 [95% CI, 0.68-0.79]), over a median follow-up of 5.8 years (interquartile range, 3.3-8.6).
Conclusions:
Almost a quarter of the patients with diabetes and non-ST-segment-elevation myocardial infarction did not receive any revascularization procedure. There was an incremental mortality reduction associated with CABG or complete revascularization with PCI, compared with incomplete revascularization with PCI or no revascularization.
More Related Videos
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:27Coronary Artery Disease V: Interprofessional Care
01:30Coronary Artery Disease III: Clinical Manifestations