Diabetes mellitus associated with an increased risk of percutaneous coronary intervention long-term adverse outcomes in Taiwan: A nationwide population-based cohort study

Wei-Wen Chen; Jan-Yow Chen; Chia-Ing Li; Chiu-Shong Liu; Wen-Yuan Lin; Chih-Hsueh Lin; Tsai-Chung Li; Cheng-Chieh Lin

doi:10.1016/j.jdiacomp.2020.107689

Diabetes mellitus associated with an increased risk of percutaneous coronary intervention long-term adverse outcomes in Taiwan: A nationwide population-based cohort study

J Diabetes Complications. 2020 Nov;34(11):107689. doi: 10.1016/j.jdiacomp.2020.107689. Epub 2020 Jul 23.

Authors

Wei-Wen Chen¹, Jan-Yow Chen², Chia-Ing Li³, Chiu-Shong Liu⁴, Wen-Yuan Lin⁵, Chih-Hsueh Lin⁵, Tsai-Chung Li⁶, Cheng-Chieh Lin⁷

Affiliations

¹ Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
² Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
³ School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
⁴ School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
⁵ School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
⁶ Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Sciences, Asia University, Taichung, Taiwan. Electronic address: tcli@mail.cmu.edu.tw.
⁷ School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. Electronic address: cclin@mail.cmuh.org.tw.

PMID: 32843281
DOI: 10.1016/j.jdiacomp.2020.107689

Abstract

Aims: This study compared the incidence rates of patients with diabetes mellitus (DM) and patients without DM with percutaneous coronary intervention (PCI) in a national population-based cohort to determine if the patients with DM have an increased risk of adverse outcomes.

Methods: We performed a retrospective cohort study among 92,624 patients with and without DM, who underwent PCI for the first time in 2000-2008. The patients were identified from National Health Insurance Program Database through propensity score matching. Endpoints were the occurrence of PCI adverse outcomes, including myocardial infarction (MI), need for target vessel revascularization by either bypass surgery or repeat PCI, all-cause mortality or 2011/12/31. Incidence rate was calculated and hazard ratios of PCI adverse events were estimated using Cox's proportional hazard regression model.

Results: During the mean six-year follow up, the rates of MI (incidence rate 20.96 vs. 15.59 per 1000 person-years), bypass surgery (incidence rate 8.15 vs. 5.15 per 1000 person-years), all-cause mortality (incidence rate 6.20 vs. 4.72 per 1000 person-years), and the composite measure of MI, repeat PCI, bypass surgery, all-cause mortality (incidence rate 37.31 vs. 28.14 per 1000 person-years) were higher in patients with DM. The corresponding hazard ratios (HRs) and their 95% confidence intervals (CIs) were 1.34 (95% CI: 1.29, 1.39), 1.46 (1.38, 1.56), 1.34 (1.25, 1.44), and 1.31 (1.27, 1.35). However, the repeat PCI rate (incidence rate 2.65 vs. 2.70 per 1000 person-years); with an adjusted HR of 0.97 (0.88, 1.07) was not statistically different.

Conclusions: This nationwide retrospective cohort study determined a positive correlation between PCI adverse events and DM. As the prevalence of DM and PCI continues to increase, novel treatments and intensified surveillance coronary angiography for high risk patients are needed.

Keywords: Diabetes; Mortality; Myocardial infarction; Percutaneous coronary intervention.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Coronary Artery Bypass
Coronary Artery Disease*
Diabetes Mellitus* / epidemiology
Humans
Incidence
Myocardial Infarction* / epidemiology
Percutaneous Coronary Intervention* / adverse effects
Retrospective Studies
Risk Factors
Taiwan / epidemiology
Treatment Outcome