Long-term outcomes of unselected patients undergoing coronary angiography according to the presence or absence of type II diabetes mellitus

Abstract

Objective: The study investigates long-term outcomes of unselected inpatients undergoing invasive coronary angiography (CA) with and without diabetes mellitus type II (T2DM).

Background: Due to continual shifts in demographics and advancements in treating cardiovascular disease, there has been a notable evolution in the types of patients undergoing CA over the past decades. Comprehensive data on the extended outcomes of CA patients, both with and without concurrent T2DM, remains scarce.

Methods: Consecutive inpatients undergoing invasive CA from 2016 to 2022 were included at one institution. The prognosis of T2DM in patients undergoing CA was investigated with regard to the risk rehospitalization for heart failure (HF), acute myocardial infarction (AMI) and coronary revascularization at 36 months of follow-up. Statistical analyses included Kaplan-Meier uni- and multivariable Cox proportional regression analyses.

Results: From 2016 to 2022, 7150 patients undergoing CA were included with a prevalence of T2DM of 31.2 %. Compared to non-diabetics, patients with T2DM had a higher prevalence (78.0 % vs. 64.3 %; p = 0.001) and extent (3-vessel disease: 36.9 % vs. 23.8 %; p = 0.001) of coronary artery disease (CAD). At 36 months, patients with T2DM had a higher risk rehospitalization for worsening HF (29.0 % vs. 18.2 %; p = 0.001), AMI (9.9 % vs. 6.6 %; p = 0.001), alongside with a higher need for coronary revascularization (10.7 % vs. 7.2 %; p = 0.001) compared to patients without. Even after multivariable adjustment, the risk of rehospitalization for HF (HR = 1.229; 95 % CI 1.099-1.374; p = 0.001), AMI (HR = 1.270; 95 % CI 1.052-1.534; p = 0.013) and coronary revascularization (HR = 1.457; 95 % CI 1.213-1.751; p = 0.001) was higher in patients with T2DM. Especially in patients with left ventricular ejection fraction (LVEF) ≥ 35 %, T2DM was associated with a higher risk of AMI- (HR = 1.395, 95 % CI: 1.104 - 1.763, p = 0.005) and PCI-related rehospitalization (HR = 1.442, 95 % CI: 1.185 - 1.775, p = 0.001).

Conclusion: In unselected patients undergoing CA, T2DM represents an independent predictor of HF-related rehospitalization, AMI- and for PCI- at 36 months.

Keywords: Coronary angiography; Coronary artery disease; Diabetes mellitus; Prognosis.