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. 2022 Apr 12;2(3):294-308.
doi: 10.1016/j.jacasi.2021.12.012. eCollection 2022 Jun.

Modifiers of the Risk of Diabetes for Long-Term Outcomes After Coronary Revascularization: CREDO-Kyoto PCI/CABG Registry

Kyohei Yamaji  1 , Hiroki Shiomi  2 , Takeshi Morimoto  3 , Yukiko Matsumura-Nakano  2 , Natsuhiko Ehara  4 , Hiroki Sakamoto  5 , Yasuaki Takeji  2 , Yusuke Yoshikawa  2 , Ko Yamamoto  2 , Eri T Kato  2 , Kazuaki Imada  1 , Takeshi Tada  6 , Ryoji Taniguchi  7 , Ryusuke Nishikawa  5 , Tomohisa Tada  5 , Takashi Uegaito  8 , Tatsuya Ogawa  9 , Miho Yamada  10 , Teruki Takeda  11 , Hiroshi Eizawa  12 , Nobushige Tamura  13 , Keiichi Tambara  14 , Satoru Suwa  15 , Manabu Shirotani  16 , Toshihiro Tamura  17 , Moriaki Inoko  18 , Junichiro Nishizawa  19 , Masahiro Natsuaki  20 , Hiroshi Sakai  21 , Takashi Yamamoto  21 , Naoki Kanemitsu  22 , Nobuhisa Ohno  23 , Katsuhisa Ishii  24 , Akira Marui  25 , Hiroshi Tsuneyoshi  26 , Yasuhiko Terai  27 , Shogo Nakayama  28 , Kazuhiro Yamazaki  29 , Mamoru Takahashi  30 , Takashi Tamura  31 , Jiro Esaki  32 , Shinji Miki  33 , Tomoya Onodera  34 , Hiroshi Mabuchi  11 , Yutaka Furukawa  4 , Masaru Tanaka  35 , Tatsuhiko Komiya  36 , Yoshiharu Soga  25 , Michiya Hanyu  37 , Takenori Domei  1 , Kenji Ando  1 , Kazushige Kadota  6 , Kenji Minatoya  29 , Yoshihisa Nakagawa  21 , Takeshi Kimura  2 ; CREDO-Kyoto PCI/CABG Registry Investigators
Collaborators, Affiliations

Modifiers of the Risk of Diabetes for Long-Term Outcomes After Coronary Revascularization: CREDO-Kyoto PCI/CABG Registry

Kyohei Yamaji et al. JACC Asia. .

Abstract

Background: Diabetes is a well-known risk factor for adverse outcomes after coronary revascularization.

Objectives: This study sought to determine high-risk subgroups in whom the excess risks of diabetes relative to nondiabetes are particularly prominent and thus may benefit from more aggressive interventions.

Methods: The study population consisted of 39,427 patients (diabetes: n = 15,561; nondiabetes: n = 23,866) who underwent first percutaneous coronary intervention (n = 33,144) or coronary artery bypass graft (n = 6,283) in the pooled CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Graft) registry. The primary outcome measure was major adverse cardiovascular and cerebral endpoints (MACCE), which was defined as a composite of all-cause death, myocardial infarction, and stroke.

Results: With median follow-up of 5.6 years, diabetes was associated with significantly higher adjusted risks for MACCE. The excess adjusted risks of diabetes relative to nondiabetes for MACCE increased with younger age (≤64 years: adjusted HR: 1.30; 95% CI: 1.19-1.41; P < 0.001; 64-73 years: adjusted HR: 1.24; 95% CI: 1.16-1.33; P < 0.001; >73 years: adjusted HR: 1.17; 95% CI: 1.10-1.23; P < 0.001; P interaction < 0.001), mainly driven by greater excess adjusted mortality risk of diabetes relative to nondiabetes in younger tertile. No significant interaction was observed between adjusted risk of diabetes relative to nondiabetes for MACCE and other subgroups such as sex, mode of revascularization, and clinical presentation of acute myocardial infarction.

Conclusions: The excess risk of diabetes relative to nondiabetes for MACCE was profound in the younger population. This observation suggests more aggressive interventions for secondary prevention in patients with diabetes might be particularly relevant in younger patients.

Keywords: AMI, acute myocardial infarction; CABG, coronary artery bypass graft; MACCE, major adverse cardiovascular and cerebral endpoints; MI, myocardial infarction; PCI, percutaneous coronary intervention; RCT, randomized controlled trial; TVR, target vessel revascularization; coronary artery bypass graft; diabetes; percutaneous coronary intervention.

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Conflict of interest statement

This study was supported by an educational grant from the Research Institute for Production Development (Kyoto, Japan). Dr Yamaji has received a research grant from Abbott Vascular. Dr Shiomi has received honoraria from Abbott Vascular and Boston Scientific. Dr Morimoto has received lecturer's fees from Bristol-Myers Squibb, Daiichi Sankyo, Japan Lifeline, Kowa, Kyocera, Novartis, and Toray; manuscript fees from Bristol-Myers Squibb and Kowa; and has served on the Advisory Board of Sanofi. Dr Ehara has received honoraria from Abbott Vascular, Bayer, Boston Scientific, Medtronic, and Terumo. Dr Furukawa has received honoraria from Bayer, Kowa, and Sanofi. Dr Nakagawa has received research grants from Abbott Vascular and Boston Scientific; and honoraria from Abbott Vascular, Bayer, and Boston Scientific. Dr Kimura has received a research grant from Abbott Vascular; and honoraria from Astellas, AstraZeneca, Bayer, Boston Scientific, Kowa, and Sanofi. All the other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Study Flowchart Among the final study population of 39,427 patients, 15,561 patients had diabetes and 23,866 patients did not have diabetes. AMI = acute myocardial infarction; CABG = coronary artery bypass graft; CREDO-Kyoto = Coronary Revascularization Demonstrating Outcome Study in Kyoto; DM = diabetes mellitus; PCI = percutaneous coronary intervention.
Figure 2
Figure 2
Kaplan-Meier Curves for the Clinical Outcome Measures: Diabetes Versus Nondiabetes Kaplan-Meier curves for (A) major adverse cardiovascular and cerebral endpoints, (B) all-cause death, (C) cardiovascular death, (D) noncardiovascular death, (E) myocardial infarction, (F) stroke, (G) target vessel revascularization, (H) any coronary revascularization, and (I) heart failure hospitalization. The Kaplan-Meier curves were truncated at 5 years.
Figure 3
Figure 3
Forest Plots for the Adjusted HRs of Diabetes Forest plots for (A) age tertiles, (B) sex, (C) mode of revascularization, and (D) clinical presentation. Cumulative incidence was represented by the values at 5 years. Number of patients with event and the HRs were estimated through the entire follow-up period. To calculate HRs and interactions, we incorporated the risk-adjusting variables listed in Table 1. Abbreviations as in Figure 1.
Figure 3
Figure 3
Forest Plots for the Adjusted HRs of Diabetes Forest plots for (A) age tertiles, (B) sex, (C) mode of revascularization, and (D) clinical presentation. Cumulative incidence was represented by the values at 5 years. Number of patients with event and the HRs were estimated through the entire follow-up period. To calculate HRs and interactions, we incorporated the risk-adjusting variables listed in Table 1. Abbreviations as in Figure 1.
Figure 3
Figure 3
Forest Plots for the Adjusted HRs of Diabetes Forest plots for (A) age tertiles, (B) sex, (C) mode of revascularization, and (D) clinical presentation. Cumulative incidence was represented by the values at 5 years. Number of patients with event and the HRs were estimated through the entire follow-up period. To calculate HRs and interactions, we incorporated the risk-adjusting variables listed in Table 1. Abbreviations as in Figure 1.
Figure 3
Figure 3
Forest Plots for the Adjusted HRs of Diabetes Forest plots for (A) age tertiles, (B) sex, (C) mode of revascularization, and (D) clinical presentation. Cumulative incidence was represented by the values at 5 years. Number of patients with event and the HRs were estimated through the entire follow-up period. To calculate HRs and interactions, we incorporated the risk-adjusting variables listed in Table 1. Abbreviations as in Figure 1.
Central Illustration
Central Illustration
Study Flowchart and Forest Plots for the Adjusted HRs of Diabetes From the pooled CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Graft) registry, we found the excess risk of diabetes relative to nondiabetes for major adverse cardiovascular and cerebral endpoints MACCE was profound in the younger population, whereas no significant interaction was observed between adjusted risk of diabetes relative to nondiabetes for MACCE and other subgroups such as sex, mode of revascularization, and clinical presentation of acute myocardial infarction.
See this image and copyright information in PMC

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