Background:
ACC guidelines suggests late outcomes in diabetic patients after percutaneous coronary intervention (PCI) are similar to non-diabetics if the hgbA1C can be maintained less than 7.0%. To achieve this level of glycemic control many patients require the addition of insulin. The differences in outcomes amongst insulin dependent (IDDM) and non-insulin dependent (NIDDM) patients are not well known. We wish to analyze the cardiovascular (CV) outcomes and glycemic control of diabetic patients 6 months post PCI stratified by insulin usage.
Methods:
We conducted a retrospective cohort study investigating the impact of DM on clinical outcomes in patients who underwent a PCI at a Veterans Health Institution from September 2004 to March 2009. Adverse cardiovascular outcomes (death, myocardial infarct, revascularization, cardiac hospitalization, and combined outcomes) six months post-PCI were recorded and compared in IDDM and NIDDM patients. Data pertaining to glucose levels, HgbA1C, lipids, and blood pressure were also collected.
Results:
Of the 771 unique patients in our analysis, 302 had DM of which, 132(44%) were on insulin and 169(56%) were on oral medications. Although not statistically significant, in IDDM patients there was an increased rate of death, MI, cardiac hospitalization, and combined outcomes. HgbA1C and glucose values in IDDM were significantly higher pre and post-PCI.
Conclusion:
Our study suggested that both IDDM and NIDDM groups had poor glycemic control, however, IDDM patients were less controlled. Although lack of power in our study may have led to our inability to detect statistically significant differences in adverse CV outcomes we can see a trend toward worse outcomes in the IDDM group. Increased attention to promote tighter glycemic control particularly among IDDM veterans is warranted. We can conclude that more attention needs to be paid to diabetics patients, especially IDDM patients, to maintain a tighter glycemic control and hence reduce adverse cardiovascular outcomes post PCI.
Impact of Glycemic Control on the Clinical Outcome in Diabetic Patients With Percutaneous Coronary Intervention
