Impact of diabetes and early revascularization on the need for late and repeat procedures
Abstract Background Coronary artery disease often progresses more rapidly in diabetics, but the integrated impact of diabetes and early revascularization status on late or repeat revascularization in the contemporary era is less clear. Methods Coronary angiography was performed in 12,420 patients be...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-02-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12933-018-0669-0 |
| _version_ | 1818984870568787968 |
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| author | Ady Orbach David A. Halon Ronen Jaffe Ronen Rubinshtein Basheer Karkabi Moshe Y. Flugelman Barak Zafrir |
| author_facet | Ady Orbach David A. Halon Ronen Jaffe Ronen Rubinshtein Basheer Karkabi Moshe Y. Flugelman Barak Zafrir |
| author_sort | Ady Orbach |
| collection | DOAJ |
| description | Abstract Background Coronary artery disease often progresses more rapidly in diabetics, but the integrated impact of diabetes and early revascularization status on late or repeat revascularization in the contemporary era is less clear. Methods Coronary angiography was performed in 12,420 patients between the years 2000–2015 and early revascularization status [none, percutaneous coronary intervention (PCI) or bypass surgery (CABG)] was determined. Subsequent revascularization procedures were recorded over a median follow-up of 67 months and its relation to diabetic and baseline revascularization status was studied. Results Early revascularization status was none in 5391, PCI in 5682 and CABG in 1347 patients. Late revascularization rates were 10, 26 and 11.1% respectively. Diabetes was present in 37%; a stepwise relationship of diabetic status with late revascularization was observed: no diabetes (reference) 14.4%, non-insulin treated diabetes 21% (adjusted HR 1.35, 95% CI 1.23–1.49, p < 0.001) and insulin-treated diabetes 32.8% (adjusted HR 2.20, 95% CI 1.91–2.54, p < 0.001), which was similar in magnitude for each early revascularization state (none, PCI or CABG). Further revascularizations (≥ 2) were also significantly more common in diabetics, in particular if insulin-treated. Glycosylated hemoglobin level was moderately associated with late revascularization in diabetics after early PCI but not following diagnostic catheterization or CABG. Conclusions Diabetic status graded by treatment, and in particular insulin therapy, is a strong predictor for late or repeat revascularization irrespective of early revascularization status. The high rate of repeat revascularization in diabetics following PCI remains a challenging issue. |
| first_indexed | 2024-12-20T18:25:52Z |
| format | Article |
| id | doaj.art-89ffc9b07c4b4044b7377b49dcf229a1 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-12-20T18:25:52Z |
| publishDate | 2018-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-89ffc9b07c4b4044b7377b49dcf229a12022-12-21T19:30:09ZengBMCCardiovascular Diabetology1475-28402018-02-011711910.1186/s12933-018-0669-0Impact of diabetes and early revascularization on the need for late and repeat proceduresAdy Orbach0David A. Halon1Ronen Jaffe2Ronen Rubinshtein3Basheer Karkabi4Moshe Y. Flugelman5Barak Zafrir6Department of Cardiovascular Medicine, Lady Davis Carmel Medical CenterDepartment of Cardiovascular Medicine, Lady Davis Carmel Medical CenterDepartment of Cardiovascular Medicine, Lady Davis Carmel Medical CenterDepartment of Cardiovascular Medicine, Lady Davis Carmel Medical CenterDepartment of Cardiovascular Medicine, Lady Davis Carmel Medical CenterDepartment of Cardiovascular Medicine, Lady Davis Carmel Medical CenterDepartment of Cardiovascular Medicine, Lady Davis Carmel Medical CenterAbstract Background Coronary artery disease often progresses more rapidly in diabetics, but the integrated impact of diabetes and early revascularization status on late or repeat revascularization in the contemporary era is less clear. Methods Coronary angiography was performed in 12,420 patients between the years 2000–2015 and early revascularization status [none, percutaneous coronary intervention (PCI) or bypass surgery (CABG)] was determined. Subsequent revascularization procedures were recorded over a median follow-up of 67 months and its relation to diabetic and baseline revascularization status was studied. Results Early revascularization status was none in 5391, PCI in 5682 and CABG in 1347 patients. Late revascularization rates were 10, 26 and 11.1% respectively. Diabetes was present in 37%; a stepwise relationship of diabetic status with late revascularization was observed: no diabetes (reference) 14.4%, non-insulin treated diabetes 21% (adjusted HR 1.35, 95% CI 1.23–1.49, p < 0.001) and insulin-treated diabetes 32.8% (adjusted HR 2.20, 95% CI 1.91–2.54, p < 0.001), which was similar in magnitude for each early revascularization state (none, PCI or CABG). Further revascularizations (≥ 2) were also significantly more common in diabetics, in particular if insulin-treated. Glycosylated hemoglobin level was moderately associated with late revascularization in diabetics after early PCI but not following diagnostic catheterization or CABG. Conclusions Diabetic status graded by treatment, and in particular insulin therapy, is a strong predictor for late or repeat revascularization irrespective of early revascularization status. The high rate of repeat revascularization in diabetics following PCI remains a challenging issue.http://link.springer.com/article/10.1186/s12933-018-0669-0Diabetes mellitusCardiac catheterizationCoronary revascularizationPercutaneous coronary intervention |
| spellingShingle | Ady Orbach David A. Halon Ronen Jaffe Ronen Rubinshtein Basheer Karkabi Moshe Y. Flugelman Barak Zafrir Impact of diabetes and early revascularization on the need for late and repeat procedures Cardiovascular Diabetology Diabetes mellitus Cardiac catheterization Coronary revascularization Percutaneous coronary intervention |
| title | Impact of diabetes and early revascularization on the need for late and repeat procedures |
| title_full | Impact of diabetes and early revascularization on the need for late and repeat procedures |
| title_fullStr | Impact of diabetes and early revascularization on the need for late and repeat procedures |
| title_full_unstemmed | Impact of diabetes and early revascularization on the need for late and repeat procedures |
| title_short | Impact of diabetes and early revascularization on the need for late and repeat procedures |
| title_sort | impact of diabetes and early revascularization on the need for late and repeat procedures |
| topic | Diabetes mellitus Cardiac catheterization Coronary revascularization Percutaneous coronary intervention |
| url | http://link.springer.com/article/10.1186/s12933-018-0669-0 |
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