Effect of diabetes mellitus on long-term survival following contemporary percutaneous coronary intervention

Background: Diabetics are known to have reduced long-term survival following percutaneous transluminal coronary angioplasty compared to nondiabetics. However, it is unknown whether this survival disadvantage has persisted in the era of contemporary percutaneous coronary intervention (PCI) techniques which include the widespread use of stents and the availability of platelet glycoprotein (GP) IIb/IIIa inhibitors. Methods and results: From a cohort of 3,834 consecutive patients undergoing PCI, 857 diabetic patients were identified who could be matched to 857 nondiabetic patients on three different criteria: decade of age, gender and extent of coronary disease (one-, two- or three-vessel). The primary endpoint was all-cause mortality following hospital discharge for PCI. Hypertension, renal insufficiency and renal failure requiring dialysis were all more common in diabetics whereas active smoking was less frequent. More diabetic than nondiabetic patients presented with unstable angina (74% vs. 69%, P = 0.047). Congestive heart failure on admission was more common in diabetics than nondiabetics (7.6% vs. 3.7%, P = 0,001). One- or two-vessel coronary disease was present in 76% of patients. Stents were placed in 79% of nondiabetics and 77% of diabetics (P = NS). Platelet GP IIb/IIIa antagonists were administered to 24% of nondiabetic and diabetic patients. At a mean follow-up of 2.4 years, mortality was 6% among nondiabetics and 11% for diabetics (P < 0.001). After adjustment for differences in baseline characteristics between nondiabetics and diabetics, diabetes remained a significant independent hazard for late mortality (RR 1.70; 95% CI 1.20 - 2.30, P = 0.003). The use of stents and GP IIb/IIIa inhibitors did not improve survival for nondiabetics or diabetics. Conclusions: Following contemporary PCI diabetic patients continue to have worse survival than nondiabetics. The use of stents and GP IIb/IIIa inhibitors do not appear to have improved late survival in nondiabetics or diabetics.