Impact of insulin treated and non‐insulin‐treated diabetes compared to patients without diabetes on 1‐year outcomes following contemporary PCI

Objective We compared 1‐year outcomes in insulin‐treated diabetes mellitus (ITDM) and non‐ITDM patients compared to nondiabetic (DM) patients following contemporary percutaneous coronary intervention (PCI). Background ITDM is associated with extensive atherosclerotic disease and worse cardiovascular prognosis compared to non‐ITDM patients. Methods We evaluated PCI patients at a large tertiary center from 2010 to 2016, grouped according to diabetes and treatment status at baseline. One‐year major adverse cardiac events (MACE) were defined as a composite of death, myocardial infarction (MI), or target vessel revascularization. Outcomes were adjusted using multivariable Cox regression methods. Results During the study period, 16,889 patients underwent PCI including 13.7% ITDM, 34.0% non‐ITDM, and 52.3% non‐DM patients. Patients with DM were younger, including more females and non‐white patients, with higher body mass index and greater prevalence of prior revascularization and chronic kidney disease. Compared to others, ITDM patients more often presented with acute coronary syndrome, in‐stent restenosis, or severe lesion calcification. There were no differences in discharge rates of dual antiplatelet therapy and statins, whereas beta‐blockers were more commonly prescribed in DM patients. At 1‐year, both ITDM and non‐ITDM patients had greater risk of MACE compared with non‐DM patients, and ITDM conferred greater adjusted risk than non‐ITDM (ITDM = HR: 2.11, 95% CI [1.79,2.50]; non‐ITDM = HR: 1.27, 95%CI [1.09,1.47]). Conclusions The negative prognostic effect of DM following contemporary PCI is heightened in the presence of insulin treatment, compared to non‐DM patients. Focus on secondary prevention, prescription of and adherence to optimal medical therapy is necessary for post‐PCI risk reduction.