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. 2018 Feb 5;17(1):25.
doi: 10.1186/s12933-018-0669-0.

Impact of diabetes and early revascularization on the need for late and repeat procedures

Ady Orbach  1 , David A Halon  1   2 , Ronen Jaffe  1   2 , Ronen Rubinshtein  1   2 , Basheer Karkabi  1 , Moshe Y Flugelman  1   2 , Barak Zafrir  3
Affiliations

Impact of diabetes and early revascularization on the need for late and repeat procedures

Ady Orbach et al. Cardiovasc Diabetol. .

Abstract

Background: Coronary artery disease often progresses more rapidly in diabetics, but the integrated impact of diabetes and early revascularization status on late or repeat revascularization in the contemporary era is less clear.

Methods: Coronary angiography was performed in 12,420 patients between the years 2000-2015 and early revascularization status [none, percutaneous coronary intervention (PCI) or bypass surgery (CABG)] was determined. Subsequent revascularization procedures were recorded over a median follow-up of 67 months and its relation to diabetic and baseline revascularization status was studied.

Results: Early revascularization status was none in 5391, PCI in 5682 and CABG in 1347 patients. Late revascularization rates were 10, 26 and 11.1% respectively. Diabetes was present in 37%; a stepwise relationship of diabetic status with late revascularization was observed: no diabetes (reference) 14.4%, non-insulin treated diabetes 21% (adjusted HR 1.35, 95% CI 1.23-1.49, p < 0.001) and insulin-treated diabetes 32.8% (adjusted HR 2.20, 95% CI 1.91-2.54, p < 0.001), which was similar in magnitude for each early revascularization state (none, PCI or CABG). Further revascularizations (≥ 2) were also significantly more common in diabetics, in particular if insulin-treated. Glycosylated hemoglobin level was moderately associated with late revascularization in diabetics after early PCI but not following diagnostic catheterization or CABG.

Conclusions: Diabetic status graded by treatment, and in particular insulin therapy, is a strong predictor for late or repeat revascularization irrespective of early revascularization status. The high rate of repeat revascularization in diabetics following PCI remains a challenging issue.

Keywords: Cardiac catheterization; Coronary revascularization; Diabetes mellitus; Percutaneous coronary intervention.

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Figures

Fig. 1
Fig. 1
Cumulative revascularization rates according to baseline coronary procedure and diabetes status. Index procedure: a diagnostic catheterization (no revascularization); b CABG. CABG coronary artery bypass graft surgery, DM diabetes mellitus, PCI percutaneous coronary intervention
Fig. 2
Fig. 2
Cumulative revascularization rates according to baseline coronary procedure and diabetes status. Index procedure: a PCI. CABG coronary artery bypass graft surgery, DM diabetes mellitus, PCI percutaneous coronary intervention
Fig. 3
Fig. 3
Adjusted hazard ratios for late or repeat revascularization according to index coronary procedure and diabetes status. *Adjustment for: age, gender, BMI, hypertension, hyperlipidemia, renal failure, smoking. CABG coronary artery bypass graft surgery, DM diabetes mellitus, HR hazard ratio, PCI percutaneous coronary intervention
Fig. 4
Fig. 4
Rate of repeat revascularization (≥ 2 procedures) in relation to index procedure and diabetes status. CABG coronary artery bypass graft surgery, Cath. catheterization, DM diabetes mellitus, PCI percutaneous coronary intervention
See this image and copyright information in PMC

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