Patients with diabetes who require insulin had an increased risk for MI and death at 1 year after PCI, regardless of whether they had chronic kidney disease, according to a study published in The American Journal of Cardiology.
Surbhi Chamaria, MD, interventional cardiology fellow at Mount Sinai Heart, Mount Sinai Hospital, and colleagues reviewed data from 17,898 patients who underwent PCI from 2009 to 2014.
Patients were categorized by their chronic kidney disease (CKD) status and the type of diabetes treatment they received.
The primary outcomes of interest were MI and death at 1 year according to CKD status and diabetes therapy (oral medications vs. insulin therapy). MI and death were the secondary outcomes of interest.
Follow-up was conducted on the phone at 30 days and 1 year after the procedure. Clinical visits and medical records were also reviewed during follow-up.
Patients without CKD who did not require insulin had an HR of 1.65 for death or MI (95% CI, 1.02-2.67); it was 3.78 (95% CI, 2.23-6.4) for those on insulin therapy. For those with CKD, the HR for death or MI was 3.34 (95% CI, 1.99-5.61) in those on oral medication and 6.26 (95% CI, 3.84-10.2) in those on insulin therapy.
For death at 1 year, rates were higher in patients on insulin therapy vs. patients with diabetes but not on insulin therapy or patients without diabetes, regardless of the presence (P = .007) or absence (P = .003) of CKD. A similar trend was seen for MI at 1 year (P < .001 for patients with and without CKD).
“Our findings are clinically relevant, as CKD and [diabetes] are highly prevalent conditions and in combination are associated with a marked increased risk of cardiovascular morbidity and mortality,” Chamaria and colleagues wrote. “Our findings suggest that this risk is further accentuated in those patients with [diabetes] requiring insulin, which is meaningful, given that approximately 1 in 4 patients with [diabetes] require such therapy.” – by Darlene Dobkowski
The authors report no relevant financial disclosures.