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Multicenter Study
. 2017 Sep;10(9):e003553.
doi: 10.1161/CIRCOUTCOMES.117.003553.

Residual Angina After Elective Percutaneous Coronary Intervention in Patients With Diabetes Mellitus

Anna Grodzinsky  1 , Mikhail Kosiborod  2 , Fengming Tang  2 , Philip G Jones  2 , Darren K McGuire  2 , John A Spertus  2 , John F Beltrame  2 , Jae-Sik Jang  2 , Abhinav Goyal  2 , Neel M Butala  2 , Robert W Yeh  2 , Suzanne V Arnold  2
Affiliations
Multicenter Study

Residual Angina After Elective Percutaneous Coronary Intervention in Patients With Diabetes Mellitus

Anna Grodzinsky et al. Circ Cardiovasc Qual Outcomes. 2017 Sep.

Abstract

Background: Previous studies suggest that among patients with stable coronary artery disease, patients with diabetes mellitus (DM) have less angina and more silent ischemia when compared with those without DM. However, the burden of angina in diabetic versus nondiabetic patients after elective percutaneous coronary intervention (PCI) has not been recently examined.

Methods and results: In a 10-site US PCI registry, we assessed angina before and at 1, 6, and 12 months after elective PCI with the Seattle Angina Questionnaire angina frequency score (range, 0-100, higher=better). We also examined the rates of antianginal medication prescriptions at discharge. A multivariable, repeated-measures Poisson model was used to examine the independent association of DM with angina over the year after treatment. Among 1080 elective PCI patients (mean age, 65 years; 74.7% men), 34.0% had DM. At baseline and at each follow-up, patients with DM had similar angina prevalence and severity as those without DM. Patients with DM were more commonly prescribed calcium channel blockers and long-acting nitrates at discharge (DM versus not: 27.9% versus 20.9% [P=0.01] and 32.8% versus 25.5% [P=0.01], respectively), whereas β-blockers and ranolazine were prescribed at similar rates. In the multivariable, repeated-measures model, the risk of angina was similar over the year after PCI in patients with versus without DM (relative risk, 1.04; range, 0.80-1.36).

Conclusions: Patients with stable coronary artery disease and DM exhibit a burden of angina that is at least as high as those without DM despite more antianginal prescriptions at discharge. These findings contradict the conventional teachings that patients with DM experience less angina because of silent ischemia.

Keywords: coronary artery disease; diabetes mellitus; myocardial ischemia; percutaneous coronary intervention; risk.

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Conflict of interest statement

The other authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of the analytic cohort
Figure 2
Figure 2. Angina burden at baseline and over the year following PCI in patients with and without DM
As assessed with the Seattle Angina Questionnaire angina frequency domain. Scores 0–30 indicate daily angina; 31–60 indicate weekly angina; 61–99 indicate monthly angina.
Figure 3
Figure 3
Kaplan-Meier curve depicting rehospitalization after PCI in patients with and without DM stratified by presence or absence of residual angina at 1 month following index PCI
See this image and copyright information in PMC

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