Introduction and aims
There is scarcity of studies that evaluate cardiovascular events and repeat revascularization among Middle Eastern patients who have long-term survival after coronary artery revascularization. In this study, patients who survived at least 10 years after percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) were assessed for the evolution of cardiovascular risk factors, occurrence of acute cardiovascular events and the need for further coronary revascularization procedures after the index coronary revascularization. Patients were classified according to the presence or absence of diabetes mellitus (DM) at baseline.
Methods
The study enrolled consecutive ambulatory or in-patients who had PCI or CABG at least 10 years prior to enrollment. Collected data included cardiovascular risk factors at the time of the index revascularization and evolution of risk factors since then, occurrence of cardiovascular events and the need for coronary revascularization after the index procedure. Events were compared between patients with DM and no DM at baseline.
Results
The study population consisted of 891 consecutive patients with 351 patients (39.4%) had DM and 540 patients (60.6%) had no DM. Of all patients, 123 (13.8%) were females with the DM group had more females compared to no DM group (19.7 vs 10%, p <0.001). Mean age of the study population at baseline was 53.9 + 8.8 years for DM patients and 53.0 + 9.8 years for no DM patients (p=0.16). At baseline, the DM group had more hypertension (70.9% vs 27.6%, p<0.0001), more dyslipidemias (12% vs 5.2%, p=0.001) but less smokers compared to no DM group (44.4% vs 58.3%, p<0.001). DM and no DM groups had similar proportion of PCI (65.5% vs 68.3%, p=0.42) and CABG at baseline (34.5% vs 31.7%, p=0.43).
The mean time elapsed since the index coronary revascularization was 13.5 + 3.5 years for DM patients and 14.4 + 4.8 years for no DM (p=0.02). Following the index revascularization procedure, ACS events occurred in 40.7% of diabetic patients and in 41.6% in no DM patients (p=0.82). Heart failure and stroke developed in similar proportions in the DM and no DM groups (12.5% vs 13.3%, p=0.51) and (4.6% vs 5.9%, p=0.75) respectively. Repeat revascularization after the index procedure showed that DM group had more PCI compared to no DM group (52.7% vs 45.4%, p= 0.04) but proportions of CABG (7.1% vs 9.8%, p=0.20).
Conclusions
In this retrospective observation of Middle Eastern patients who survived at least a decade after coronary revascularization, DM group had more hypertension and dyslipidemias but less smokers compared to no DM at baseline. During follow up, DM group required more PCI revascularization compared with no DM group.