ClinicalDifferential Impact of Type 1 and Type 2 Diabetes Mellitus on Outcomes Among 1.4 Million US Patients Undergoing Percutaneous Coronary Intervention
Graphical abstract
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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Association of Diabetes Mellitus and Its Types with In-Hospital Management and Outcomes of Patients with Acute Myocardial Infarction
2023, Cardiovascular Revascularization MedicineLong-term cardiovascular prognosis of patients with type 1 diabetes after myocardial infarction
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2022, Diabetes CareGlycaemic Control in Patients Undergoing Percutaneous Coronary Intervention: What Is the Role for the Novel Antidiabetic Agents? A Comprehensive Review of Basic Science and Clinical Data
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Joint second authors.