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Research Article| Volume 295, P45-53, February 2020

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

Published:January 15, 2020DOI:https://doi.org/10.1016/j.atherosclerosis.2020.01.002
Association of diabetes with outcomes in patients undergoing contemporary percutaneous coronary intervention: Pre-specified subgroup analysis from the randomized GLOBAL LEADERS study
Previous ArticleReversal of endothelial dysfunction post-immunosuppressive therapy in adult-onset podocytopathy and primary membranous nephropathy

      Highlights

      • •
        Diabeticstreated with contemporary PCI still had a higher risk of adverse ischemic events compared to non-diabetics
      • •
        The risk of bleeding and stent thrombosis was comparable amongst non-diabetics and diabetics.
      • •
        Long-term ticagrelor monotherapy did not affect the outcomes of diabeticsfollowing percutaneous coronary intervention.

      Abstract

      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.

      Graphical abstract

      Image 1
      Graphical Abstract

      Keywords

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      Article info

      Publication history

      Published online: January 15, 2020
      Accepted: January 9, 2020
      Received in revised form: November 25, 2019
      Received: August 15, 2019

      Identification

      DOI: https://doi.org/10.1016/j.atherosclerosis.2020.01.002

      Copyright

      © 2020 Elsevier B.V. All rights reserved.

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