Patency of percutaneous transluminal coronary angioplasty sites at 6-monthangiographic follow-up - A key determinant of survival in diabetics after coronary balloon angioplasty

Background-Several reports have demonstrated a high mortality rate in diabe tic patients treated by standard coronary balloon angioplasty. No clear exp lanation has been provided for this finding. Methods and Results-Consecutive diabetic patients successfully treated by s tandard coronary balloon angioplasty (n=604) were enrolled in a follow-up p rogram including repeated angiography at 6 months and long-term clinical fo llow-up. Clinical follow-up was available in 603 patients (99.8%). Twelve p atients died, 2 underwent bypass surgery before scheduled repeated angiogra phy, and 76 declined angiography. Determinants of long-term mortality were analyzed in the 513 patients with angiography at 6 months and long-term cli nical follow-up (mean follow-up, 6.5 +/- 2,4 years). On the basis of the re sults of repeated angiography, 3 groups of patients were defined: group 1, 162 patients without restenosis (32%): group 2, 257 patients with nonocclus ive restenosis (50%); and group 3, 94 patients with coronary occlusion (18% ). Overall actuarial 10-year mortality rate was 36%. Actuarial 10-year mort ality was 24% in group 1, 35% in group 2, and 59% in group 3 (P < 0.0001). Multivariate analysis demonstrated that coronary occlusion was a strong and independent correlate of long-term total mortality (hazard ratio, 2.16; 95 % CI, 1.43 to 3.26; P=0.0003) and cardiac mortality (hazard ratio, 2.38; 95 % CI, 1.48 to 3.85; P=0.0004). Conclusions-This study demonstrates that restenosis, especially in its occl usive form. is a major determinant of long-term mortality in diabetic patie nts after coronary balloon angioplasty.