Insulin-treated diabetes tied to elevated MACE risk 1 year after PCI
At 1 year after PCI, patients with insulin-treated diabetes experienced greater risk for MACE compared with patients with no diabetes, researchers reported.
Patients with noninsulin-treated diabetes also had greater MACE risk than those without diabetes, but to a lesser degree, according to the researchers.
“The negative prognostic effect of diabetes following contemporary PCI is heightened in the presence of insulin treatment, compared to non-diabetes patients,” Jaya Chandrasekhar, MBBS, MS, postdoctoral research fellow at Icahn School of Medicine at Mount Sinai, and colleagues wrote. “Focus on secondary prevention, prescription of and adherence to optimal medical therapy is necessary to effect post-PCI risk reduction. Prolonged dual antiplatelet therapy beyond 12 months should be reviewed against the risk of bleeding given the high prevalence of chronic kidney disease and anemia in these individuals.”
For the study, published in Catheterization and Cardiovascular Interventions, researchers stratified 16,889 patients who underwent PCI at a large tertiary center from 2010 to 2016 by diabetes and treatment status at baseline to evaluate differences in 1 year outcomes. MACE was defined as death, MI or target vessel revascularization.
Among the cohort, 13.7% of patients had insulin-treated diabetes, 34% had noninsulin-treated diabetes and 52.3% did not have diabetes. Additionally, patients with diabetes were more likely to be younger, to be women, to be from an underrepresented group, to have a higher BMI and to have comorbidities including prior revascularization and chronic kidney disease (P for all < .0001).
At 1 year, both diabetes groups had higher risk for MACE compared with patients without diabetes, but the degree of risk was greatest in those with insulin-treated diabetes (HR for insulin-treated diabetes vs. no diabetes = 2.11; 95% CI, 1.79-2.5; HR for non-insulin treated diabetes vs. no diabetes = 1.27; 95% CI, 1.09-1.47).
Both diabetes groups also had elevated risk for target lesion revascularization, TVR, MI and all-cause death compared with patients without diabetes, and the risk for each outcome was greatest in patients with insulin-treated diabetes, according to the researchers.
“Despite the use of new generation stents, the rate of TLR is higher in insulin-treated diabetes patients,” the researchers wrote. “In our study, although lesion factors varied between the groups including greater in-stent restenosis at baseline and smaller stent diameter in insulin-treated diabetes patients, procedural success rates and final TIMI 3 flow were similar. However, importantly, the significant differences in the rates of MI suggest that non-stent-related risks are also greater in insulin-treated diabetes patients, and prolonged dual antiplatelet therapy, particularly with potent P2Y12 inhibitors, may be considered in these patients.”