open access

Vol 27, No 2 (2020)
Original articles — Clinical cardiology
Published online: 2018-09-07
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Diabetes and periprocedural outcomes in patients treated with rotablation during percutaneous coronary interventions

Rafał A. Januszek, Artur Dziewierz, Zbigniew Siudak, Tomasz Rakowski, Jacek Legutko, Łukasz Rzeszutko, Paweł Kleczyński, Dariusz Dudek, Stanisław Bartuś
DOI: 10.5603/CJ.a2018.0102
·
Pubmed: 30234901
·
Cardiol J 2020;27(2):152-161.

open access

Vol 27, No 2 (2020)
Original articles — Clinical cardiology
Published online: 2018-09-07

Abstract

Background: This study is to assess differences in periprocedural outcomes among diabetic and non-diabetic patients treated with percutaneous coronary intervention (PCI) and rotational atherectomy (RA).

Methods: Under assessment were 221,187 patients from the Polish Cardiovascular Intervention Society national registry (ORPKI) including all PCIs performed in Poland in 2015 and 2016. Data was extracted of 975 patients treated with RA — 336 (34.5%) diabetics and 639 (65.5%) non-diabetics. Periprocedural complications were defined as overall rate or particular complications such as deaths, no-reflows, perforations, dissections, cerebral strokes or bleedings. Multivariate analysis was performed to assess predictors of periprocedural complications.

Results: The mean age was similar in diabetics and non-diabetics (70.9 ± 9.0 vs. 72.1 ± 9.9; p = 0.06). Diabetics were more often females (p < 0.01), with arterial hypertension (p < 0.01), kidney failure (p < 0.01) and prior myocardial infarction (p = 0.01). No significant differences were observed in overall or individual periprocedural complications and angiographic success was expressed as thrombolysis in myocardial infarction grade 3 flow after PCI. At baseline, de-novo lesions accounted for 96.5% in diabetics and 99% in non-diabetics (p < 0.01), while overall rate of restenosis was 3.5% and 1%, respectively (p < 0.01). Diabetes was an independent predictor of periprocedural complications in the overall group of patients treated with PCI (OR 1.11, 95% CI 1.04–1.194; p < 0.001).

Conclusions: The negative impact of diabetes on the incidence of periprocedural complications and angiographic effectiveness in the group of patients treated with RA is mitigated in the comparison to the non-RA group.

Abstract

Background: This study is to assess differences in periprocedural outcomes among diabetic and non-diabetic patients treated with percutaneous coronary intervention (PCI) and rotational atherectomy (RA).

Methods: Under assessment were 221,187 patients from the Polish Cardiovascular Intervention Society national registry (ORPKI) including all PCIs performed in Poland in 2015 and 2016. Data was extracted of 975 patients treated with RA — 336 (34.5%) diabetics and 639 (65.5%) non-diabetics. Periprocedural complications were defined as overall rate or particular complications such as deaths, no-reflows, perforations, dissections, cerebral strokes or bleedings. Multivariate analysis was performed to assess predictors of periprocedural complications.

Results: The mean age was similar in diabetics and non-diabetics (70.9 ± 9.0 vs. 72.1 ± 9.9; p = 0.06). Diabetics were more often females (p < 0.01), with arterial hypertension (p < 0.01), kidney failure (p < 0.01) and prior myocardial infarction (p = 0.01). No significant differences were observed in overall or individual periprocedural complications and angiographic success was expressed as thrombolysis in myocardial infarction grade 3 flow after PCI. At baseline, de-novo lesions accounted for 96.5% in diabetics and 99% in non-diabetics (p < 0.01), while overall rate of restenosis was 3.5% and 1%, respectively (p < 0.01). Diabetes was an independent predictor of periprocedural complications in the overall group of patients treated with PCI (OR 1.11, 95% CI 1.04–1.194; p < 0.001).

Conclusions: The negative impact of diabetes on the incidence of periprocedural complications and angiographic effectiveness in the group of patients treated with RA is mitigated in the comparison to the non-RA group.

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Keywords

percutaneous coronary interventions, rotational atherectomy, periprocedural complications, angiographic effectiveness, in-stent restenosis, diabetics, predictors, coronary artery calcifications

About this article
Title

Diabetes and periprocedural outcomes in patients treated with rotablation during percutaneous coronary interventions

Journal

Cardiology Journal

Issue

Vol 27, No 2 (2020)

Pages

152-161

Published online

2018-09-07

DOI

10.5603/CJ.a2018.0102

Pubmed

30234901

Bibliographic record

Cardiol J 2020;27(2):152-161.

Keywords

percutaneous coronary interventions
rotational atherectomy
periprocedural complications
angiographic effectiveness
in-stent restenosis
diabetics
predictors
coronary artery calcifications

Authors

Rafał A. Januszek
Artur Dziewierz
Zbigniew Siudak
Tomasz Rakowski
Jacek Legutko
Łukasz Rzeszutko
Paweł Kleczyński
Dariusz Dudek
Stanisław Bartuś

References (29)
  1. Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham study. JAMA. 1979; 241(19): 2035–2038.
  2. Vigorito C, Betocchi S, Bonzani G, et al. Severity of coronary artery disease in patients with diabetes mellitus. Angiographic study of 34 diabetic and 120 nondiabetic patients. Am Heart J. 1980; 100(6 Pt 1): 782–787.
  3. Wong ND, Nelson JC, Granston T, et al. Metabolic syndrome, diabetes, and incidence and progression of coronary calcium: the Multiethnic Study of Atherosclerosis study. JACC Cardiovasc Imaging. 2012; 5(4): 358–366.
  4. Niles NW, McGrath PD, Malenka D, et al. Northern New England Cardiovascular Disease Study Group. Survival of patients with diabetes and multivessel coronary artery disease after surgical or percutaneous coronary revascularization: results of a large regional prospective study. Northern New England Cardiovascular Disease Study Group. J Am Coll Cardiol. 2001; 37(4): 1008–1015.
  5. Stein B, Weintraub WS, Gebhart SP, et al. Influence of diabetes mellitus on early and late outcome after percutaneous transluminal coronary angioplasty. Circulation. 1995; 91(4): 979–989.
  6. Kip KE, Faxon DP, Detre KM, et al. Coronary angioplasty in diabetic patients. The National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. Circulation. 1996; 94(8): 1818–1825.
  7. Levine G, Jacobs A, Keeler G, et al. Impact of Diabetes Mellitus on Percutaneous Revascularization (CAVEAT-I). Am J Cardiol. 1997; 79(6): 748–755.
  8. Januszek R, Siudak Z, Dziewierz A, et al. Predictors of in-hospital effectiveness and complications of rotational atherectomy (from the ORPKI Polish National Registry 2014-2016). Catheter Cardiovasc Interv. 2017 [Epub ahead of print].
  9. Siudak Z, Tokarek T, Dziewierz A, et al. Reduced periprocedural mortality and bleeding rates of radial approach in ST-segment elevation myocardial infarction. Propensity score analysis of data from the ORPKI Polish National Registry. EuroIntervention. 2017; 13(7): 843–850.
  10. Rzeszutko Ł, Tokarek T, Siudak Z, et al. Patient profile and periprocedural outcomes of bioresorbable vascular scaffold implantation in comparison with drug-eluting and bare-metal stent implantation. Experience from ORPKI Polish National Registry 2014-2015. Postepy Kardiol Interwencyjnej. 2016; 12(4): 321–328.
  11. Barbato E, Carrié D, Dardas P, et al. European Association of Percutaneous Cardiovascular Interventions. European expert consensus on rotational atherectomy. EuroIntervention. 2015; 11(1): 30–36.
  12. Teirstein PS, Warth DC, Haq N, et al. High speed rotational coronary atherectomy for patients with diffuse coronary artery disease. J Am Coll Cardiol. 1991; 18(7): 1694–1701.
  13. Farkouh ME, Domanski M, Sleeper LA, et al. FREEDOM Trial Investigators. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med. 2012; 367(25): 2375–2384.
  14. Mack MJ, Banning AP, Serruys PW, et al. Bypass versus drug-eluting stents at three years in SYNTAX patients with diabetes mellitus or metabolic syndrome. Ann Thorac Surg. 2011; 92(6): 2140–2146.
  15. Bangalore S, Kumar S, Fusaro M, et al. Outcomes with various drug eluting or bare metal stents in patients with diabetes mellitus: mixed treatment comparison analysis of 22,844 patient years of follow-up from randomised trials. BMJ. 2012; 345: e5170.
  16. Kato K, Yonetsu T, Kim SJ, et al. Comparison of nonculprit coronary plaque characteristics between patients with and without diabetes: a 3-vessel optical coherence tomography study. JACC Cardiovasc Interv. 2012; 5(11): 1150–1158.
  17. Nicoll R, Zhao Y, Ibrahimi P, et al. Diabetes and hypertension consistently predict the presence and extent of coronary artery calcification in symptomatic patients: a systematic review and meta-analysis. Int J Mol Sci. 2016; 17(9): 1481.
  18. Milzi A, Burgmaier M, Burgmaier K, et al. Type 2 diabetes mellitus is associated with a lower fibrous cap thickness but has no impact on calcification morphology: an intracoronary optical coherence tomography study. Cardiovasc Diabetol. 2017; 16(1): 152.
  19. Jia H, Abtahian F, Aguirre AD, et al. In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography. J Am Coll Cardiol. 2013; 62(19): 1748–1758.
  20. Zimoch WJ, Kubler P, Kosowski M, et al. Patients with acute myocardial infarction and severe target lesion calcifications undergoing percutaneous coronary intervention have poor long-term prognosis. Kardiol Pol. 2017; 75(9): 859–867.
  21. Giustino G, Mastoris I, Baber U, et al. Correlates and Impact of Coronary Artery Calcifications in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents: From the Women in Innovation and Drug-Eluting Stents (WIN-DES) Collaboration. JACC Cardiovasc Interv. 2016; 9(18): 1890–1901.
  22. Généreux P, Madhavan MV, Mintz GS, et al. Ischemic outcomes after coronary intervention of calcified vessels in acute coronary syndromes. Pooled analysis from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) TRIALS. J Am Coll Cardiol. 2014; 63(18): 1845–1854.
  23. Januszek R, Siudak Z, Dziewierz A, et al. Chronic obstructive pulmonary disease affects the angiographic presentation and outcomes of patients with coronary artery disease treated with percutaneous coronary interventions. Pol Arch Intern Med. 2018; 128(1): 24–34.
  24. Fitzgerald PJ, Ports TA, Yock PG. Contribution of localized calcium deposits to dissection after angioplasty. An observational study using intravascular ultrasound. Circulation. 1992; 86(1): 64–70.
  25. Mak KH, Faxon DP. Clinical studies on coronary revascularization in patients with type 2 diabetes. Eur Heart J. 2003; 24(12): 1087–1103.
  26. Kishi K, Hiasa Y, Ogata T, et al. Comparison of results of rotational atherectomy for diffuse coronary artery disease in diabetics versus nondiabetics. Am J Cardiol. 2001; 87(7): 894–896.
  27. Stein B, Weintraub WS, Gebhart SP, et al. Influence of diabetes mellitus on early and late outcome after percutaneous transluminal coronary angioplasty. Circulation. 1995; 91(4): 979–989.
  28. Kip KE, Faxon DP, Detre KM, et al. Coronary angioplasty in diabetic patients. The National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. Circulation. 1996; 94(8): 1818–1825.
  29. Orbach A, Halon DA, Jaffe R, et al. Impact of diabetes and early revascularization on the need for late and repeat procedures. Cardiovasc Diabetol. 2018; 17(1): 25.

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