INFLUENCE OF DIABETES-MELLITUS ON EARLY AND LATE OUTCOME AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Background Although patients with diabetes mellitus constitute an impo rtant segment of the population undergoing coronary angioplasty, the o utcome of these patients has not been well characterized. Methods and Results Data for 1133 diabetic and 9300 nondiabetic patients undergoin g elective angioplasty from 1980 to 1990 were analyzed. Diabetics were older and had more cardiovascular comorbidity. Insulin-requiring (IR) diabetics had diabetes for a longer duration and worse renal and vent ricular functions compared with non-IR subjects. Angiographic and clin ical successes after angioplasty were high and similar in diabetics an d nondiabetics. In-hospital major complications were infrequent (3%), with a trend toward higher death or myocardial infarction in IR diabet ics. Five-year survival (89% versus 93%) and freedom from infarction ( 81% versus 89%) were lower, and bypass surgery and additional angiopla sty were required more often in diabetics. In diabetics, only 36% surv ived free of infarction or additional revascularization compared with 53% of nondiabetics, with a marked attrition in the first year after a ngioplasty, when restenosis is most common. Multivariate correlates of decreased 5-year survival were older age, reduced ejection fraction, history of heart failure, multivessel disease, and diabetes. IR diabet ics had worse long-term survival and infarction-free survival than non -IR diabetics. Conclusions Coronary angioplasty in diabetics is associ ated with high success and low complication rates. Although longterm s urvival is acceptable, diabetics have a higher rate of infarction and a greater need for additional revascularization procedures, probably b ecause of early restenosis and late progression of coronary disease. T he most appropriate treatment for these patients remains to be determi ned.