Clinical
Differential Impact of Type 1 and Type 2 Diabetes Mellitus on Outcomes Among 1.4 Million US Patients Undergoing Percutaneous Coronary Intervention

https://doi.org/10.1016/j.carrev.2021.08.018Get rights and content

Highlights

  • Patients with diabetes mellitus have worse outcomes with percutaneous coronary intervention.

  • Patients with type 1 diabetes mellitus are a particularly high-risk cohort.

  • These discrepancies are particularly present in the acute coronary syndrome setting.

Abstract

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.

Introduction

The International Diabetes Federation (IDF) has estimated that 700 million people will be living with diabetes mellitus (DM) by 2045 [1]. The metabolic abnormalities arising from DM result in vascular dysfunction that predisposes diabetic patients to coronary atherosclerosis [2,3]. Percutaneous coronary intervention (PCI) remains the commonest means of revascularization in patients with DM, both in the elective and acute setting. Despite advances in interventional technologies and the new-generation drug-eluting stents (DES), studies have shown worse angiographic and clinical outcomes among diabetic patients undergoing PCI, including target lesion revascularization (TLR), target vessel failure (TVF), stent thrombosis (ST), as well as major adverse cardiovascular and cerebrovascular events (MACCE) [[4], [5], [6], [7]]. While previous studies have examined the impact of insulin treatment in PCI outcomes in patients with diabetes [[8], [9], [10]], these have been mainly derived from patients with type 2 DM (T2DM). There is limited data comparing PCI outcomes according to type 1 DM (T1DM) and T2DM subgroups. Our study addresses this knowledge gap through analysis of the impact of DM on patients undergoing PCI, according to the DM subtype.

Section snippets

National Inpatient Sample database

The National Inpatient Sample (NIS) database is the largest healthcare database of the routinely collected data in the United States (US) comprising >7 million hospitalizations which weighted correspond to >35 million hospitalizations each year. It contains anonymized discharge data from >7 million hospitals covering approximately 20% stratified sample of the community hospitals from all US regions. It is designed by the Agency for Healthcare Research and Quality (AHRQ) under the Healthcare

Results

A total of 1,363,800 patients who underwent PCI during hospitalization were included in the study (Supplementary Fig. 1). There were 811,470 patients (59.5%) in the group of patients that did not have prevalent DM, 12,640 patients (0.9%) in the T1DM group and 539,690 patients (39.6%) in the T2DM group (Table 1).

There were more females (47.8% vs. 30.4% vs. 36.9%, p < 0.001) and younger patients (median: 57 vs. 65 vs. 66 years, p < 0.001) in the T1DM group compared to the control and T2DM group

Discussion

To the best of our knowledge, this is the first study to evaluate PCI outcomes in patients according to DM subtype in a large and contemporary patient sample. The most important finding of the current analysis is that both the characteristics of patients with diabetes and their outcomes of depends on diabetes subtype, with those with T1DM representing a younger, multi-morbid cohort with the greatest odds of MACCE, all-cause mortality, and stroke following PCI.

Previous studies have evaluated PCI

CRediT authorship contribution statement

Andrija Matetic: Data curation, Methodology, Formal analysis, Visualization, Validation, Writing – review & editing. Gemina Doolub: Methodology, Writing – original draft, Writing – review & editing, Validation. Aditya Bharadwaj: Methodology, Writing – original draft, Writing – review & editing, Validation. Mohammed Osman: Validation, Writing – review & editing. Giuseppe Biondi-Zoccai: Validation, Writing – review & editing. Waqas Ullah: Validation, Writing – review & editing. Rodrigo Bagur:

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

None.

Authorship

All authors take full responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Funding disclosure

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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