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Long-term outcomes of older diabetic patients after percutaneous coronary stenting in the United States: a report from the National Cardiovascular Data Registry, 2004 to 2008.

Publication ,  Journal Article
Hillegass, WB; Patel, MR; Klein, LW; Gurm, HS; Brennan, JM; Anstrom, KJ; Dai, D; Eisenstein, EL; Peterson, ED; Messenger, JC; Douglas, PS
Published in: J Am Coll Cardiol
December 4, 2012

OBJECTIVES: The purpose of this study was to characterize long-term outcomes of percutaneous coronary intervention (PCI) in elderly diabetic patients in routine practice. BACKGROUND: Although drug-eluting stent (DES) implantation in diabetic patients is common practice, pivotal randomized trials enrolled <2,500 diabetic patients, most of whom were <65 years of age. METHODS: Data from 405,679 patients ≥65 years old (33% had diabetes mellitus, of whom 9.8% had insulin-treated diabetes mellitus [ITDM], and 23.3% had noninsulin-treated diabetes mellitus [NITDM]) undergoing PCI from 2004 to 2008 at 946 U.S. hospitals were linked with Medicare inpatient claims data. RESULTS: Over 18.4 months median follow-up (25th to 75th percentile: 8.0 to 30.8 months), ITDM/NITDM were associated with significantly increased adjusted hazards of death (hazard ratio [HR]: 1.91 [95% confidence interval (CI): 1.86 to 1.96], p < 0.001/HR: 1.32 [95% CI: 1.29 to 1.35], p < 0.001) and myocardial infarction (HR: 1.87 [95% CI: 1.79 to 1.95], p < 0.001/HR: 1.29 [95% CI: 1.25 to 1.34], p < 0.001) compared with nondiabetic patients. The adjusted hazard of undergoing additional revascularization procedures (HR: 1.14 [95% CI: 1.10 to 1.18, p < 0.001/HR: 1.08 [95% CI: 1.05 to 1.10], p < 0.001) and subsequent hospitalization for bleeding (HR: 1.40 [95% CI: 1.31 to 1.50], p < 0.001/HR: 1.18 [95% CI: 1.13 to 1.24], p < 0.001) were also significantly increased. Compared with nondiabetic patients, there were similar excess risks associated with ITDM/NITDM in patients selected for DES and BMS use; selection for use of DES was associated with reductions in death in ITDM/NITDM and myocardial infarction in ITDM, but not NITDM. There were no significant interactions between diabetes status and stent type for revascularization or bleeding. CONCLUSIONS: One-third of older patients undergoing PCI have diabetes. After adjustment for other comorbidities, diabetes, particularly ITDM, remains independently and strongly associated with increased long-term adverse events after both DES and BMS implantation.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

December 4, 2012

Volume

60

Issue

22

Start / End Page

2280 / 2289

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Stents
  • Registries
  • Prospective Studies
  • Percutaneous Coronary Intervention
  • Male
  • Humans
  • Follow-Up Studies
 

Citation

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Hillegass, W. B., Patel, M. R., Klein, L. W., Gurm, H. S., Brennan, J. M., Anstrom, K. J., … Douglas, P. S. (2012). Long-term outcomes of older diabetic patients after percutaneous coronary stenting in the United States: a report from the National Cardiovascular Data Registry, 2004 to 2008. J Am Coll Cardiol, 60(22), 2280–2289. https://doi.org/10.1016/j.jacc.2012.08.993
Hillegass, William B., Manesh R. Patel, Lloyd W. Klein, Hitinder S. Gurm, J Matthew Brennan, Kevin J. Anstrom, David Dai, et al. “Long-term outcomes of older diabetic patients after percutaneous coronary stenting in the United States: a report from the National Cardiovascular Data Registry, 2004 to 2008.J Am Coll Cardiol 60, no. 22 (December 4, 2012): 2280–89. https://doi.org/10.1016/j.jacc.2012.08.993.
Hillegass WB, Patel MR, Klein LW, Gurm HS, Brennan JM, Anstrom KJ, et al. Long-term outcomes of older diabetic patients after percutaneous coronary stenting in the United States: a report from the National Cardiovascular Data Registry, 2004 to 2008. J Am Coll Cardiol. 2012 Dec 4;60(22):2280–9.
Hillegass, William B., et al. “Long-term outcomes of older diabetic patients after percutaneous coronary stenting in the United States: a report from the National Cardiovascular Data Registry, 2004 to 2008.J Am Coll Cardiol, vol. 60, no. 22, Dec. 2012, pp. 2280–89. Pubmed, doi:10.1016/j.jacc.2012.08.993.
Hillegass WB, Patel MR, Klein LW, Gurm HS, Brennan JM, Anstrom KJ, Dai D, Eisenstein EL, Peterson ED, Messenger JC, Douglas PS. Long-term outcomes of older diabetic patients after percutaneous coronary stenting in the United States: a report from the National Cardiovascular Data Registry, 2004 to 2008. J Am Coll Cardiol. 2012 Dec 4;60(22):2280–2289.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

December 4, 2012

Volume

60

Issue

22

Start / End Page

2280 / 2289

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Stents
  • Registries
  • Prospective Studies
  • Percutaneous Coronary Intervention
  • Male
  • Humans
  • Follow-Up Studies