The impact of diabetes mellitus and hypertension on clinical outcomes in a population of Iranian patients who underwent percutaneous coronary intervention: A retrospective cohort study

There are heterogeneous data regarding the impact of diabetes mellitus (DM) and hypertension (HTN) on clinical outcomes after percutaneous coronary intervention (PCI). This study explored the effect of history of DM (hDM) and HTN (hHTN), separately and in combination with each other, on major adverse cardiac events (MACE) in short‐, mid‐, and long‐term intervals after PCI. Between 2000 and 2017, 1799 patients who had PCI were registered. They were categorized in four different groups: hDM, hHTN, hDM + hHTN, and no hDMQuery no hHTN. Incidence of myocardial infarction, revascularization, and coronary death totally considered as MACE was sought in short‐ (<24 hours), mid‐ (24 hours up to 6 months), and long‐term (more than 6 months) intervals after PCI. Among the subjects, 176 had hDM, 648 had hHTN, 370 had hDM + hHTN, and 605 were in no hDM no hHTN group. The median follow‐up time was 66.5 months. Time‐to‐event (time to the first MACE) was not significantly different between four groups. hHTN group was older and hDM group was younger at the time of enrollment PCI. Female gender was dominant only in hDM + hHTN group. Of the total, 130 patients (7.22%) experienced MACE. There was no MACE in short term, 23.07% of the MACEs were in mid‐term, and the remaining happened in long term. However, according to the rate ratio, incidence rate of MACE in mid‐tem was significantly higher than the long term. Also, MACE occurrence was significantly higher in hDM + hHTN and hHTN groups than the no hDM no hHTN group. Our study showed that the history of HTN significantly increases post‐PCI MACE rather than the history of DM. Having history of both DM and HTN synergistically raised MACE incidence. Incidence of MACE per month was higher in mid‐term than the long‐term interval.     

An increase in HbA1c after percutaneous coronary intervention raises the risk for restenosis in patients without Type 2 diabetes mellitus

Aims The influence of dynamic changes in glycated haemoglobin (HbA_1c) on restenosis after elective percutaneous coronary intervention (PCI) in patients without diabetes has not been analysed. Therefore, the rate of restenosis was investigated after elective PCI in 101 consecutive patients without diabetes mellitus in relation to dynamic changes of HbA_1c levels. Methods Follow‐up angiography was performed in all patients 4–6 months after intervention. Results Multivariate analysis demonstrated that the change in HbA_1c between first and second coronary angiography was the most powerful metabolic parameter for prediction of restenosis. The odds ratio for restenosis was 3.0 (95% CI 1.0–9.0) for any increase in HbA_1c and 1.9 (95% CI 1.1–3.5) for an HbA_1c increase of 0.2%. Conclusions Hence, chronic changes in the glucometabolic environment influence the incidence of restenosis after PCI in patients without diabetes.     

Risk factors of in-stent restenosis in patients with diabetes mellitus after percutaneous coronary intervention: A protocol for systematic review and meta-analysis

Background:Percutaneous coronary intervention (PCI) has become one of the effective methods for the treatment of coronary heart disease (CHD). However, it is easy to have in-stent restenosis (ISR), even cardiovascular events after PCI, which affects the therapeutic effects. The incidence of ISR in diabetes mellitus (DM) patients increased by 2 to 4 times. Early identification of the risk factors of ISR in DM patients after PCI may help clinical staff to prevent and intervene as soon as possible, so it is very important to improve the clinical outcomes of DM patients. Although scholars at home and abroad have studied and summarized the risk factors of ISR in DM patients after PCI, the conclusions are different. Therefore, in this study, meta-analysis was used to summarize the risk factors of ISR in DM patients after PCI, and to explore the characteristics of high-risk groups of ISR, thus providing reference for early identification and prevention of ISR.Methods:We will search related literature from PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database. Eligible studies will be screened based on inclusion criteria. Meanwhile, data extraction, risk of bias assessment, publication bias assessment, subgroup analysis, and quality assessment will be performed. Review Manager Version 5.3 software will be applied for data analysis. Each process is independently conducted by 2 researchers. If there is any objection, it will be submitted to a third researcher for resolution.Results:We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals.Conclusions:The results of this analysis can be used to generate a risk prediction model and provide an intervention strategy for the occurrence of ISR in DM patients after PCI.OSF REGISTRATION NUMBER:DOI 10.17605/OSF.IO/WC87Y.     

急性冠状动脉综合征伴糖尿病患者应用磺达肝癸钠的疗效及安全性研究

目的:探讨行经皮冠状动脉介入治疗(PCI)的急性冠状动脉综合征(ACS)伴糖尿病(DM)患者应用磺达肝癸钠的有效性及安全性。方法:将156例行PCI的ACS伴DM患者随机分为依诺肝素组和磺达肝癸钠组,每组78例,比较2组患者术后24h、30d和180d的主要不良心血管事件(MACE)及出血发生率。结果:依诺肝素组和磺达肝癸钠组患者PCI术后24h、30d和180d的MACE发生率均差异无统计学意义(术后24h,10.3%∶5.1%,P=0.367;术后30d,6.4%∶3.8%,P=0.717;术后180d,5.1%∶2.6%,P=0.677);磺达肝癸钠组患者术后24h轻微出血并发症发生率显著低于依诺肝素组(5.1%∶20.5%,P=0.008)。2组患者小出血并发症发生率差异无统计学意义,且均未发生主要出血并发症。结论:对行PCI的ACS伴DM患者,应用磺达肝癸钠的有效性及安全性良好。     

合并糖尿病的冠心病患者PCI治疗后氯吡格雷抵抗的影响因素

目的探讨合并糖尿病的冠状动脉粥样硬化性心脏病（冠心病）患者经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗后氯吡格雷抵抗的影响因素。方法159例行PCI治疗的冠心病患者,其中糖尿病患者56例,非糖尿病患者103例,术前予氯吡格雷300mg负荷剂量治疗,术后予75mg／d持续治疗。测其服药前、术后24h和术后5d以5μmol／L的二磷酸腺苷诱导的血小板最大聚集率。以血小板聚集抑制率≤10％定义为氯吡格雷抵抗。比较两组临床基线资料、相关常规检查、手术资料。Logistic回归分析糖尿病患者氯吡格雷抵抗的独立危险因素。结果糖尿病组发生氯吡格雷抵抗的比例为48．2％,显著高于非糖尿病组的20．4％,差异有统计学意义（P〈0．05）。糖尿病组三酰甘油浓度显著高于非糖尿病组,差异有统计学意义（P〈0．05）。两组其他基线资料比较,差异无统计学意义（P〉0．05）。Logistic回归分析结果显示糖尿病史（年）（β=0．243,OR=1．184,P=0．028）是糖尿病患者氯吡格雷抵抗的独立危险因素。结论合并糖尿病的冠心病患者存在更高的氯吡格雷抵抗比例。糖尿病史（年）是糖尿病患者PCI治疗后发生氯吡格雷抵抗的独立危险因素。     

合并糖尿病患者行冠状动脉左主干病变介入治疗的疗效分析

目的探讨冠状动脉左主干病变合并糖尿病患者行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的疗效。方法回顾性分析87例(糖尿病组36例,非糖尿病组51例)冠状动脉左主干病变患者接受PCI治疗的临床资料,比较糖尿病与非糖尿病患者行冠状动脉左主干PCI治疗的方法、疗效和随访结果。结果两组基线资料比较,差异无统计学意义(P0.05)。除外糖尿病组左主干合并前降支病变的比例高于非糖尿病组外,两组病变部位及合并病变冠状动脉分支的比例比较,差异无统计学意义(P0.05)。两组支架植入成功率比较,差异无统计学意义[100%(36/36)vs.98%(50/51),P0.05]。两组介入治疗的各项结果比较,差异无统计学意义(P0.05)。两组PCI治疗后1年各项冠状动脉造影及血管内超声检查结果比较,差异无统计学意义(P0.05),随访期间冠状动脉造影和血管内超声检查均未发现左主干支架内有局部血栓的影象学表现。共83例患者随访到2007年12月,临床随访率95.4%(83/87),随访时间(31.8±6.3)个月。至随访结束,2例死亡,病死率2.4%(2/83),共有7例复发心绞痛,4例经造影证实为左主干支架内再狭窄。结论合并糖尿病的左主干病变患者,在血管内超声指导下进行介入治疗可以获得与非糖尿病患者相同的治疗效果。     

氯吡格雷抵抗对老年冠心病合并糖尿病患者介入治疗预后的影响及其危险因素

目的 观察接受冠脉介入治疗的合并2型糖尿病(T2DM,简称DM)的老年冠心病患者中氯吡格雷抵抗的发生情况及相应的危险因素、并评估其对介入治疗预后的影响.方法 连续选取于解放军总医院住院接受氯吡格雷治疗的合并DM的老年冠心病患者232例,进行血栓弹力图检测,ADP诱导的血小板抑制率大于50%者为对照组(n＝142),抑制率低于50%者为观察组(n＝90).观察两组冠脉介入术前临床危险因素、糖代谢、脂代谢及炎症指标水平的差异,评价围手术期心肌梗死及死亡发生率的差异.结果 观察组与对照组的年龄、性别、体质量指数(BMI)、吸烟史、高血压及高脂血症发生率、用药情况、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)以及糖化血红蛋白(HbA1c)水平的差异均无统计学意义(P>0.05).观察组的高密度脂蛋白胆固醇(HDL-C)水平明显偏低,空腹血糖(FPG)、糖化血清蛋白(GSP)以及超敏C反应蛋白(hs-CRP)水平明显增高(均P<0.01).与对照组相比,观察组院内发生围手术期心肌梗死的比例明显升高(P<0.01),死亡发生率的差异则无统计学意义(P>0.05).结论 合并DM的老年冠心病患者存在明显氯吡格雷抵抗现象,氯吡格雷抵抗患者术后心肌梗死的风险明显增加,FPG、GSP、hs-CRP水平增高与HDL-C水平降低可能是老年患者氯吡格雷抵抗的危险因素.     

Comparative outcomes of percutaneous coronary interventions in diabetics vs non-diabetics with prior coronary artery bypass grafting.

AIMS: To determine the influence of diabetes on outcome after percutaneous coronary intervention in patients with prior coronary artery bypass grafting. METHODS AND RESULTS: Patients with prior coronary artery bypass grafting undergoing percutaneous coronary intervention from 1 January 1996, to 31 August 2000, were divided into two groups based on whether or not they had diabetes, excluding patients with acute infarction or shock. Cox proportional hazards models were utilized to estimate the association between diabetes and adverse events. One thousand one hundred and fifty-three post-coronary artery bypass grafting percutaneous coronary intervention patients were identified (326 diabetics and 827 non-diabetics). Diabetics were younger, more likely to have hypertension, heart failure, and lower ejection fraction. Procedural characteristics and angiographic and procedural success rates were similar. Diabetes was associated with increased mortality (hazard ratio 1.58, 95% confidence intervals 1.10-2.27). Diabetes did not have a significant effect on mortality in patients treated for single-territory coronary disease (hazard ratio 1.44, 95% confidence intervals 0.69-3.02), but did in patients with multi-territory disease (hazard ratio 1.79, 95% confidence intervals 1.16-2.76). However, in diabetics with multi-territory disease who were completely revascularized with percutaneous coronary intervention, mortality was comparable to non-diabetics (hazard ratio 1.32, 95% confidence intervals 0.57-3.03). CONCLUSION: Among percutaneous coronary intervention patients with prior coronary artery bypass grafting, diabetes portends an adverse prognosis.     

Coronary artery bypass grafting versus percutaneous coronary intervention in patients with noninsulin treated type 2 diabetes mellitus: A meta‐analysis of randomized controlled trials

Background

The outcomes and prognosis of revascularization by either coronary artery bypass grafting (CABG) surgery or percutaneous coronary intervention (PCI) in patients with noninsulin‐treated type 2 diabetes mellitus (NITDM) have not yet been well established.

Methods

Randomized controlled trials (RCTs) were identified by searching Pubmed, EMBASE, and Cochrane library from inception until May 2016. Heterogeneity was evaluated, and the pooled hazard ratio (HR) was calculated by using a fixed‐effect model. A random‐effect model was used when statistically significant heterogeneity was observed (I² ≥ 50%). All data analyses were carried out by using RevMan 5.3 and STATA software 12.0.

Results

A total of 4 RCTs involving 5 studies, consisting of 2270 patients with noninsulin‐treated type 2 diabetes mellitus, were identified. Compared with CABG‐treated patients, PCI‐treated patients had significantly higher all‐cause mortality (HR 1.39; 95% CI 1.01 to 1.91; P = .04), myocardial infarction (HR 2.14; 95% CI 1.40 to 3.27; P = .0004), repeated revascularization (HR 2.52; 95% CI 1.77 to 3.57; P < .00001), and major adverse cardiovascular and cerebrovascular events (HR 1.50; 95% CI 1.20‐1.87; P = .0004). However, PCI was associated with lower incidence of stoke (HR 0.47; 95% CI 0.24 to 0.90; P = .02).

Conclusions

In NITDM patients, our study suggests that CABG surgery is associated with reduced risk of mortality and morbidity, although with increased incidence of stroke compared with percutaneous coronary intervention. The decision if to have percutaneous coronary intervention or CABG surgery should factor the risk for stroke of the patients when considering CABG over percutaneous coronary intervention. Adequately powered RCTs are needed to confirm the results of this meta‐analysis.     

糖尿病对选择性经皮冠状动脉介入治疗操作及住院期临床事件的影响

目的　比较冠心病合并与不合并糖尿病的患者选择性经皮冠状动脉介入治疗 (PCI)操作及住院期临床事件发生率,分析糖尿病对选择性PCI操作及住院期临床事件的影响。方法　对2002年 1月至 12月在本院连续进行的全部 1294例选择性PCI并置入支架的患者进行回顾性分析,搜集患者临床资料、介入治疗操作技术特点、住院期间各项预后事件。计算PCI操作成功率、支架置入成功率以及临床成功率,用逐步logistic回归模型分析糖尿病对急性期临床事件的影响。结果　糖尿病患者占总体的 20 .8%,糖尿病患者C型病变、双支、三支病变发生率明显高于非糖尿病者 (P<0 .05)。糖尿病组术前狭窄程度、预扩张球囊平均长度、最大直径、最大充盈压力以及最长充盈时间均显著大于非糖尿病组[分别为 (91 .00±6 .62)%对 (89 .81±6 .64)%, (17. 07±6. 31)mm对 (16 .07±7 .28)mm, (2 .30±1 .11)mm对(2 .12±0 .94)mm, (9 .86±4 .40)atm对(9 05±4 75)atm, (20 .94±14 .69)s对(18. 26±14 .65)s,P<0 .05],而所置入支架平均直径较小 [ ( 3 .15±0 .47 )mm对 ( 3 .23±0. 43)mm,P<0. 05]。糖尿病组与非糖尿病组之间的PCI操作成功率、临床成功率差异无统计学意义(分别为 89 6%对 90 .3%, 99 .3%对 99 .2%,P>0. 05),糖尿病不是发生急性期终     

Randomized clinical trial of abluminus DES+ sirolimus-eluting stent versus everolimus-eluting DES for percutaneous coronary intervention in patients with diabetes mellitus: An optical coherence tomography study

Background

Diabetic patients are at higher risk of recurrent adverse events following percutaneous coronary intervention (PCI) than the nondiabetics. Despite the introduction of new generation drug-eluting stents, their efficacy in the diabetics is still limited.

Aims

To evaluate the efficacy of the Abluminus DES+ biodegradable polymer sirolimus-eluting stent in reducing neointimal hyperplasia in diabetic patients, compared to a durable polymer everolimus-eluting stent (DP-EES).

Methods

A total of 131 patients with diabetes and coronary artery disease were enrolled in six Italian centers and randomized in a 2:1 fashion to PCI with Abluminus DES+ or DP-EES: 85 were assigned to Abluminus DES+ and 46 to DP-EES. The primary endpoint was optimal coherence tomography (OCT)-derived neointimal volume at 9–12 months. Secondary endpoints included OCT-derived neointimal area, neointimal volume obstruction and adverse clinical events.

Results

The primary endpoint, neointimal volume, did not differ between Abluminus DES+ and DP-EES (29.11 ± 18.90 mm³ vs. 25.48 ± 17.04 mm³, p = 0.40) at 9–12-month follow-up. This finding remained consistent after weighing for the sum of stents lengths (1.14 ± 0.68 mm³ vs. 0.99 ± 0.74 mm³ for Abluminus DES+ and DP-EES, respectively, p = 0.38). Similarly, other OCT-derived and clinical secondary endpoints did not significantly differ between the two groups. Rate of target lesion failure was high in both groups (21.2% for Abluminus DES+ and 19.6% for DP-EES).

Conclusions

This preliminary study failed to demonstrate the superiority of the Abluminus DES+ over the DP-EES in diabetic patients in terms of neointimal proliferation.