Association of diabetes with outcomes in patients undergoing contemporary percutaneous coronary intervention: Pre-specified subgroup analysis from the randomized GLOBAL LEADERS study.

Chichareon, Ply; Modolo, Rodrigo; Kogame, Norihiro; Takahashi, Kuniaki; Chang, Chun-Chin; Tomaniak, Mariusz; Botelho, Roberto; Eeckhout, Eric; Hofma, Sjoerd; Trendafilova-Lazarova, Diana; Kőszegi, Zsolt; Iñiguez, Andres; Wykrzykowska, Joanna J; Piek, Jan J; Garg, Scot; Hamm, Christian; Steg, Philippe Gabriel; Jüni, Peter; Vranckx, Pascal; Valgimigli, Marco; ... (2020). Association of diabetes with outcomes in patients undergoing contemporary percutaneous coronary intervention: Pre-specified subgroup analysis from the randomized GLOBAL LEADERS study. Atherosclerosis, 295, pp. 45-53. Elsevier 10.1016/j.atherosclerosis.2020.01.002

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BACKGROUND AND AIMS

Diabetes has been well recognized as a strong predictor for adverse outcomes after percutaneous coronary intervention (PCI), however, studies in the era of drug-eluting stent and potent P2Y12 inhibitors have shown conflicting results. We aimed to assess ischemic and bleeding outcomes after contemporary PCI according to diabetic status.

METHODS

We studied 15,957 patients undergoing PCI for stable or acute coronary syndrome in the GLOBAL LEADERS study with known baseline diabetic status. The primary endpoint was all-cause death or new Q-wave myocardial infarction at 2 years. The secondary safety endpoint was major bleeding defined as bleeding academic research consortium (BARC) type 3 or 5.

RESULTS

A quarter of the study cohort were diabetic (4038/15,957), and these patients had a significantly higher risk of primary endpoint at 2 years compared to non-diabetics (adjusted hazard ratio [HR] 1.38; 95% confidence interval [CI] 1.17-1.63). The difference was driven by a significantly higher risk of all-cause mortality at 2 years in diabetics (adjusted HR 1.47, 95% CI 1.22-1.78). The risk of BARC 3 or 5 bleeding was comparable between the two groups (adjusted HR 1.09, 95% CI 0.86-1.39). The antiplatelet strategy (experimental versus reference strategy) had no significant effect on the rates of primary endpoint and secondary safety endpoint at 2 years in patients with and without diabetes.

CONCLUSIONS

Diabetic patients had higher risk of ischemic events after PCI than non-diabetic patients, whilst bleeding risk was comparable. The outcomes of diabetic patients following PCI were not affected by the two different antiplatelet strategies.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Valgimigli, Marco and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0021-9150

Publisher:

Elsevier

Language:

English

Submitter:

Nadia Biscozzo

Date Deposited:

19 Nov 2020 17:28

Last Modified:

19 Nov 2020 17:28

Publisher DOI:

10.1016/j.atherosclerosis.2020.01.002

PubMed ID:

32006758

Uncontrolled Keywords:

Coronary artery disease Diabetes Drug-eluting stents Percutaneous coronary intervention Ticagrelor

BORIS DOI:

10.7892/boris.147471

URI:

https://boris.unibe.ch/id/eprint/147471

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