Cardiac Versus Non-Cardiac Related Mortality Following Percutaneous Coronary Intervention in Patients with Insulin-Treated Type 2 Diabetes Mellitus: A Meta-Analysis

Cardiac Versus Non-Cardiac Related Mortality Following Percutaneous Coronary Intervention in... Diabetes Ther (2018) 9:1335–1345 https://doi.org/10.1007/s13300-018-0444-y ORIGINAL RESEARCH Cardiac Versus Non-Cardiac Related Mortality Following Percutaneous Coronary Intervention in Patients with Insulin-Treated Type 2 Diabetes Mellitus: A Meta-Analysis . . Qiang Wang Hao Liu Jiawang Ding Received: April 26, 2018 / Published online: May 19, 2018 The Author(s) 2018 carried out using RevMan version 5.3 software, ABSTRACT and data were reported with odds ratios (OR) and 95% confidence intervals (CI) as the main Introduction: Cardiovascular mortality is a parameters. major concern for patients with type 2 diabetes Results: A total of 4072 participants with ITDM mellitus (T2DM). Insulin therapy significantly were included, of whom 1658 participants and contributes to a high rate of death in these 2414 participants were extracted from random- patients. We have performed a meta-analysis ized controlled trials and observational cohorts, comparing cardiac and non-cardiac-related respectively. Analysis of all data showed that mortality following percutaneous coronary death due to cardiac causes was significantly intervention (PCI) in a sample of patients with higher in patients with ITDM (OR 2.16, 95% CI insulin-treated type 2 diabetes mellitus (ITDM). 1.79–2.59; P = 0.00001). At 1 year of follow-up, Methods: Studies were included in the meta- cardiac death was still significantly higher analysis if: (1) they were trials or cohort studies compared to non-cardiac death (OR 2.39, 95% involving patients with T2DM post-PCI; (2) the CI 1.47–3.88; P = 0.0004), and this result did outcomes in ITDM were separately reported; not change with a longer follow-up period (3–- and (3) they reported cardiac death and non- 5 years) (OR 2.09, 95% CI 1.70–2.56; cardiac death among their clinical endpoints. P = 0.00001). Death due to cardiac causes was ITDM patients with any degree of coronary still significantly higher in the subpopulations artery disease were included. The analysis was of patients with everolimus-eluting stents (OR 2.31, 95% CI 1.26–4.26; P = 0.007), paclitaxel- Enhanced digital features To view enhanced digital eluting stents (OR 2.36, 95% CI 1.63–3.39; features for this article go to https://doi.org/10.6084/ P = 0.00001), sirolimus-eluting stents (OR 2.11, m9.figshare.6247415. 95% CI 1.67–2.67; P = 0.00001), and zotar- olimus-eluting stents (OR 2.12, 95% CI Q. Wang  J. Ding (&) 1.11–4.05; P = 0.02), respectively. Institute of Cardiovascular Diseases, Yichang Central People’s Hospital, Yichang 443000, Hubei, Conclusions: Mortality due to cardiac causes People’s Republic of China was significantly higher than that due to non- e-mail: 183246397@qq.com cardiac causes in patients with ITDM who had H. Liu undergone PCI. The same conclusion could be Institute of Cardiovascular Diseases, The Second drawn from analyses focused on different fol- Affiliated Hospital of Guangxi Medical University, low-up periods, types of coronary stents, and Nanning 530021, Guangxi, People’s Republic of type of study data used. China 1336 Diabetes Ther (2018) 9:1335–1345 words/index terms were used to identify articles Keywords: Cardiovascular disease; Cardiac mortality; Insulin-treated type 2 diabetes of possible interest: – T2DM ? PCI, or mellitus; Non-cardiac mortality; Percutaneous – T2DM ? coronary angioplasty, or coronary intervention – T2DM ? PCI, or – ITDM ? PCI, or INTRODUCTION – Cardiac death ? ITDM ? PCI. In this era of modern medicine, nearly three Inclusion and Exclusion Criteria hundred and fifty million cases of diabetes have been diagnosed to date worldwide [1]. Mortality Studies were included in the meta-analysis is a great concern among this patient popula- review if: (1) they were trials or cohort studies tion, especially in those with type 2 diabetes based on patients with T2DM following PCI; (2) mellitus (T2DM) in co-existence with cardio- they separately reported outcomes in patients vascular disease (CVD). Values calculated by the with ITDM; (3) they reported cardiac death and World Health Organization show that there are non-cardiac death among their endpoints. approximately three million deaths annually Studies were excluded from the systematic due to T2DM and its related complications [2]. review if: (1) they did not involve patients with Cardiovascular mortality, which was evaluated T2DM following PCI; (2) they did not separately in the Second Cardiovascular Outcome Trial report patients with ITDM; (3) they did not report Summit of the Diabetes and Cardiovascular cardiac death among their clinical outcomes; (4) Disease (D&CVD) EASD Study Group [3], is also they were repeated studies or duplicate studies. a major health risk factor in the population of patients with T2DM. Participants T2DM is an independent cause of mortality. Although data from the Korean National Health All participants in the studies ultimately inclu- Insurance Service–National Sample Cohort ded in our systematic review were patients with showed that 78% of diabetes-related deaths ITDM. However, the extent of the coronary could not be ascribed to diabetes [4], other artery disease varied among studies and inclu- studies have shown that in T2DM patients with ded ITDM patients with stable coronary artery CVD who were re-vascularized by percutaneous disease, de novo coronary artery disease, acute coronary intervention (PCI), insulin therapy myocardial infarction, single-vessel coronary significantly contributed to a high death rate [5]. artery disease, multi-vessel coronary artery dis- We have therefore conducted a meta-analy- ease (Table 1). sis to compare cardiac- versus non-cardiac-re- lated mortalityfollowing PCI in a sample of patients with insulin-treatedtype 2 diabetes Definition of Endpoints mellitus (ITDM). To date, few studies have sys- tematically assessed cardiac versus non-cardiac In this analysis, cardiac death was compared mortality in such patients following PCI. with non-cardiac death in diabetic patients who received insulin treatment. Therefore, the main focus was on: (1) cardiac mortality: death due to METHODS cardiac causes; (2) non-cardiac mortality: death which was not related to cardiac causes. Searched Databases and Key Words/Index Terms Data Extraction and Review We systematically and thoroughly searched the The following data were extracted by three MEDLINE/PubMed, EMBASE, Cochrane library, reviewers independently of each other: (1) and Google Scholar databases. the following key Diabetes Ther (2018) 9:1335–1345 1337 Table 1 Participants with insulin-treatedtype 2 diabetes mellitus and coronary artery disease participating in the studies included in the systematic review First author/year/reference of studies Coronary artery disease status of study participants Diabetes status of included in the meta-analysis study participants Antoniucci 2004 [9] Acute myocardial infarction ITDM Bangalore 2016 [10] Stable coronary artery disease ITDM Banning 2010 [11] Left main and/or three-vessel coronary artery disease ITDM Dangas 2014 [12] Multiple-vessel coronary artery disease ITDM Jain 2010 [13] Single- or multi-vessel coronary artery disease ITDM Kappetein 2013 [14] Complex coronary artery disease: de novo three-vessel ITDM and/or left main coronary artery disease Kirtane 2008 [15] Single de novo lesion in a native coronary artery ITDM Kirtane 2009 [16] Stable coronary artery disease ITDM Mehran 2004 [17] Multi-vessel coronary artery disease ITDM Nakamura 2010 [18] Coronary artery disease ITDM Simek 2013 [19] All corner patients with coronary artery disease ITDM Tada 2011 [20] Coronary artery disease ITDM ITDM insulin-treated type 2 diabetes mellitus patients with ITDM; (2) the number of events test (the lower the value, the lower the corresponding to cardiac death; (3) the number heterogeneity). of events corresponding to non-cardiac death; A fixed (I \ 50%) effects model or a random (4) baseline features; (5) methodological fea- (I [ 50%) model was used based on the value tures of each study; (5) type of study. of I that was obtained. The methodological qualities for the ran- domized controlled trials were assessed by using Compliance with Ethics Guidelines the guidelines set down in the Cochrane Handbook for Systematic Reviews of Interven- This meta-analysis is based on previously con- tions [6]. The Newcastle–Ottawa Scale (NOS) [7] ducted studies and does not contain any studies was used to assess the methodological qualities with human participants or animals performed for the observational studies. by any of the authors. Statistical Analysis RESULTS The computer program RevMan version 5.3 Searched Outcomes (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) was used as analytical software. Odds ratios (ORs) We followed the PRISMA guideline for this analysis [8]. with 95% confidence intervals (CIs) were cal- culated. Heterogeneity was assessed by two A total of 1368 publications were identified from the database search using the chosen key meta-analytical methods: (1) The Cochrane Q statistic test (a P value of B 0.05 indicates a words/index terms. Publications were excluded and eliminated based on the following criteria: statistically significant result); (2) the I statistic 1338 Diabetes Ther (2018) 9:1335–1345 – They were not related to the aim of this eluting stents DES, specifically everolimus-elut- meta-analysis (n = 1282). ing stents (EES), paclitaxel-eluting stents (PES), – They did not report cardiovascular death, sirolimus-eluting stents (SES), and zotarolimus- but instead reported total death among their eluting stents (ZES), as shown in Table 2. clinical outcomes (n = 12). The baseline features of the participants with – They were meta-analyses or review articles ITDM are given in Table 3. Based on the features themselves (n = 5). which are listed, there was no significant dif- – They did not separately report patients with ference between those patients who died due to ITDM (n = 21). a cardiac cause and those who died due to a – They were duplicates of the same study non-cardiac cause. (n = 36). The methodological qualities of the studies Ultimately, a total number of 12 articles (6 were also assessed. RCTs were assessed with the randomized controlled trials [RCTs] and 6 recommended features of the Cochrane collab- observational cohorts) [9–20] were included in oration guidelines [6]. Grades were given to this meta-analysis, as shown in Fig. 1. define the limit of bias (low, low to moderate, moderate, and high). For the observational studies, NOS scores [7] were given, with a General and Baseline Features maximum number of nine points (a higher of the Participants score indicates better quality study), as shown in Table 4. A total number of 4072 patients with ITDM who participated in 12 observational studies/RCTs Death Due to Cardiac Versus Non-cardiac were included in this meta-analysis. Of these, Causes Following PCI in Patients 1658 participants were extracted from RCTs and with ITDM 2414 participants were extracted from observa- tional studies. Two studies had a follow-up period of \ 1 year, four studies had a follow-up Analysis of the combined data extracted from period of 1 year, and six studies had a follow-up the included RCTs and observational studies period of [ 1 [range 3–5] year). One study revealed that death due to cardiac causes was reported patients who were treated with a bare significantly higher in patients with ITDM than metal stent, whereas all of the other studies death due to non-cardiac causes(OR 2.16, 95% involved patients who were treated with drug- Fig. 1 Flow diagram of study selection. ITDM Insulin-treated type 2 diabetes mellitus Diabetes Ther (2018) 9:1335–1345 1339 Table 2 Total number of events and other features of the studies included in the meta-analysis First author/year/ Type of Number of Number of Total Duration Type of stent reference of studies study patients with patients number of of follow- included in the cardiac with non- patients up period meta-analysis death cardiac death Antoniucci 2004 [9] Observational 16 6 84 6 months – Bangalore 2016 [10] RCT 18 8 747 1 year PES, EES Banning 2010 [11] RCT 9 2 88 1 year PES Dangas 2014 [12] RCT 42 20 325 5 years DES (SES and PES) Jain 2010 [13] Observational 29 14 644 1 year ZES Kappetein 2013 [14] RCT 16 5 89 5 years PES Kirtane 2008 [15] RCT 15 13 265 4 years PES, BMS Kirtane 2009 [16] RCT 0 0 144 1 year ZES, PES Mehran 2004 [17] Observational 1 1 81 In-hospital – Nakamura 2010 Observational 13 10 200 3 years SES [18] Simek 2013 [19] Observational 63 25 489 3 years EES, SES, PES Tada 2011 [20] Observational 149 80 996 3 years SES RCT randomized controlled trials, BMS bare metal stent, SES sirolimus eluting stents, DES drug eluting stents, ZES zotarolimus eluting stents, EES everolimus eluting stents, PES paclitaxel eluting stents CI 1.79–2.59; P = 0.00001; I = 0%) when higher in these patients with ITDM (OR 2.09, (Fig. 2). 95% CI 1.70–2.56; P = 0.00001; I = 15%) However, data from RCTs and observational (Fig. 6). studies were also analyzed separately. When we When the participants were analyzed based considered only data obtained from RCTs in the on the type of stents, death due to cardiac analysis, death from cardiac causes was still causes was still significantly higher in those significantly higher in patients with ITDM (OR patients having an EES (OR 2.31, 95% CI 2 2 2.20, 95% CI 1.54–3.14; P = 0.0001; I = 14%) 1.26–4.26; P = 0.007, I = 0%) compared to (Fig. 3).Similarly, when we considered only data those a PES (OR 2.36, 95% CI 1.63–3.39; obtained from observational cohorts, death due P = 0.00001; I = 0%), SES (OR 2.11, 95% CI to cardiac causes was significantly higher in the 1.67–2.67; P = 0.00001; I = 21%), or ZES (OR ITDM patients (OR 2.14, 95% CI 1.73–2.66; 2.12, 95% CI 1.11–4.05; P = 0.02), as shown in P = 0.00001; I = 0%) (Fig. 4). Fig. 7. When all the studies with a follow-up period of 1 year were analyzed together, cardiac death DISCUSSION was still significantly higher in patients with ITDM compared to non-cardiac death (OR 2.39, Cardiovascular death is a major concern among 95% CI 1.47–3.88; P = 0.0004; I = 0%) (Fig. 5). patients with T2DM who are treated by PCI. The When studies with longer follow-up periods results of our meta-analysis show that cardio- were considered (range 3–5 years), mortality vascular death in patients with ITDM who have due to cardiac causes was still significantly 1340 Diabetes Ther (2018) 9:1335–1345 Table 3 Baseline features of the participants First author/year/reference Age (years) Males (%) Hypertension Dyslipidemia Current Body mass of studies included in the (%) (%) smoker (%) index (kg/ meta-analysis m ) CD NCD CD NCD CD NCD CD NCD CD NCD CD NCD Antoniucci 2004 [9] 69.0 69.0 65.0 65.0 40.0 40.0 30.0 30.0 20.0 20.0 – - Bangalore 2016 [10] 58.5 58.5 71.0 71.0 65.6 65.6 76.2/ 76.2 12.3 12.3 26.1 26.1 Banning 2010 [11] 65.4 65.4 71.0 71.0 69.9 69.9 81.5 81.5 15.8 15.8 29.5 29.5 Dangas 2014 [12] 62.6 62.6 61.3 61.3 87.5 87.5 – - 17.9 17.9 30.5 30.5 Jain 2010 [13] 66.6 66.6 62.2 62.2 82.1 82.1 67.9 67.9 13.9 13.9 – - Kappetein 2013 [14] 65.4 65.4 71.0 71.0 70.0 70.0 82.0 82.0 16.0 16.0 29.5 29.5 Kirtane 2008 [15] 63.0 63.0 64.7 64.7 82.1 82.1 74.0 74.0 18.4 18.4 – - Kirtane 2009 [16] 63.3 63.3 71.0 71.0 76.7 76.7 81.4 81.4 64.8 64.8 – - Mehran 2004 [17] 63.0 63.0 52.0 52.0 77.0 77.0 71.0 71.0 11.0 11.0 – - Nakamura 2010 [18] 66.2 66.2 66.2 66.2 68.1 68.1 58.0 58.0 12.1 12.1 24.0 24.0 Simek 2013 [19] 65.1 65.1 69.2 69.2 70.6 70.6 65.5 65.5 32.1 32.1 28.8 28.8 Tada 2011 [20] 66.7 66.7 67.0 67.0 76.0 76.0 – - 16.0 16.0 24.1 24.1 CD Cardiac death, NCD non-cardiac death undergone PCI was significantly higher that An 11-year retrospective analysis of death death due to non-cardiac causes. This result certificates in Shanghai also showed an remained consistent even when data from the increasing occurrence of CVD among Chinese RCTs and observational studies were analyzed patients who had previously developed diabetes separately. mellitus [21], with 29.9% of deaths among To assess the effect of differences in follow- those diabetic patients due to cardiovascular up periods on the cause of death in this patient causes; in comparison, other causes represented group, we also separately analyzed the data only small percentages. However, causes of from all of the studies included in the meta- death based specifically on patients with ITDM analysis which reported a follow-up period of were not analyzed in that study. 1 year. As reported in the ‘‘Results’’ section, Finally, even though research has shown cardiac death was still significantly higher in diabetes mellitus to be independently associ- this subpopulation of patients with ITDM. ated with death due to CVD, other studies have When a longer follow-up period (3–5 years) was shown that insulin therapy also makes a major considered, the major cause of death remained contribution to such an outcome [5, 22]. In cardiovascular. addition, female gender and higher co-mor- We also assessed the impact of coronary bidities have also been suggested to further stents on the results by analyzed the data from contribute to such outcomes [23]. These factors all studies based on the types of coronary stents should further be investigated in future studies. which were implanted (EES, PES, SES, and ZES). There are a few limitations to our analysis. However, cardiovascular cause of death was still First, the total number of patients was relatively significantly higher in the patients with ITDM. small, especially for the analysis on impact of Diabetes Ther (2018) 9:1335–1345 1341 Table 4 Assessment of bias risk First author/year/reference of studies included in the meta-analysis Bias risk grade/score Bias status RCTs (Cochrane assessment) Kirtane 2009 [16] B Low to moderate Bangalore 2016 [10] A Low Banning 2010 [11] A Low Dangas 2014 [12] A Low Kirtane 2008 [15] B Low to moderate Kappetein 2013 [14] B Low to moderate Observational studies (NOS assessment) Antoniucci 2004 [9] 6 Moderate Jain 2010 [13] 8 Low Mehran 2004 [17] 6 Moderate Nakamura 2010 [18] 6 Moderate Simek 2013 [19] 7 Low Tada 2011 [20] 6 Moderate NOS Newcastle–Ottawa Scale Fig. 2 Cardiac versus non-cardiac death following percutaneous coronary intervention (PCI) in patients with ITDM. CI Confidence interval, M–H Mantel–Haenszel test types of coronary stents on cause of death in artery disease, left main coronary artery disease, patients with ITDM treated by PCI. Second, data and acute myocardial infarction) were com- from different categories of participants (those bined and analyzed. Third, the anti-platelet with stable coronary artery disease, multi-vessel agents which were used post-PCI were not taken coronary artery disease, single-vessel coronary 1342 Diabetes Ther (2018) 9:1335–1345 Fig. 3 Cardiac versus non-cardiac death following PCI in patients with ITDM based only on data obtained from randomized controlled trials Fig. 4 Cardiac versus non-cardiac death following PCI in ITDM based only on data obtained from observational cohorts Fig. 5 Cardiac versus non-cardiac death following PCI in ITDM during a follow-up period of 1 year Fig. 6 Cardiac versus non-cardiac death following PCI in ITDM during a longer follow-up period (range 3–5 years) Diabetes Ther (2018) 9:1335–1345 1343 Fig. 7 Cardiac versus non-cardiac death following PCI in ITDM according to drug-eluting stents into consideration and this might also have had ACKNOWLEDGEMENTS an impact on the mortality rate. Funding. No funding or sponsorship was CONCLUSIONS received for this study or publication of this article. In patients with ITDM, mortality due to cardiac causes was significantly higher than that due to Authorship. All named authors meet the non-cardiac causes following PCI. The same International Committee of Medical Journal conclusion was reached when different lengths Editors (ICMJE) criteria for authorship for this of follow-up periods were assessed, when dif- article, take responsibility for the integrity of ferent data sets were used (total data set, data the work as a whole, and have given their from the observational cohort or RCTs sepa- approval for this version to be published. rately), and when types of coronary stents which were implanted were assessed. 1344 Diabetes Ther (2018) 9:1335–1345 Summit of the Diabetes and Cardiovascular Disease Authorship Contributions. Qiang Wang, (D&CVD) EASD Study Group. Cardiovasc Diabetol. Hao Liu, and Jiawang Ding were responsible for 2017;16(1):35. the conception and design, acquisition of data, analysis and interpretation of data, drafting the 4. Kang YM, Kim YJ, Park JY, Lee WJ, Jung CH. Mor- tality and causes of death in a national sample of initial manuscript, and critical revision of the type 2 diabetic patients in Korea from 2002 to 2013. manuscript for important intellectual content. Cardiovasc Diabetol. 2016;15(1):131. Qiang Wang wrote the manuscript and is the first author. 5. Bundhun PK, Li N, Chen MH. Adverse cardiovas- cular outcomes between insulin-treated and non- insulin treated diabetic patients after percutaneous Disclosures. The authors Qiang Wang, Hao coronary intervention: a systematic review and Liu and Jiawang Ding have nothing to disclose. meta-analysis. Cardiovasc Diabetol. 2015;14:135. They do not have any personal, financial, commercial, or academic conflicts of interest. 6. Higgins JP, Thompson SG, Deeks JJ, et al. Assessing risk of bias in included studies. In: Cochrane handbook for systematic reviews of interventions. Compliance with Ethics Guidelines. This Wiley; 2008. p. 187–241. meta-analysis is based on previously conducted studies and does not contain any studies with 7. Wells GA, Shea B, O’Connell D, et al. The New- human participants or animals performed by castle–Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. 2009. any of the authors. http://www.ohri.ca/programs/clinical_ epidemiology/oxford.htm. Accessed 19 Oct 2009. Data Availability. All data generated or analyzed during this study are included in this 8. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and published article. meta-analyses of studies that evaluate health- careinterventions: explanation and elaboration. Open Access. This article is distributed BMJ. 2009;339:b2700. under the terms of the Creative Commons Attribution-NonCommercial 4.0 International 9. Antoniucci D, Valenti R, Migliorini A, et al. Impact of insulin requiring diabetes mellitus on effective- License (http://creativecommons.org/licenses/ ness of reperfusion and outcome of patients by-nc/4.0/), which permits any non- undergoing primary percutaneous coronary inter- commercial use, distribution, and reproduction vention for acute myocardial infarction. Am J Car- in any medium, provided you give appropriate diol. 2004;93(9):1170–72. credit to the original author(s) and the source, 10. Bangalore S, Bhagwat A, Pinto B, et al. Percutaneous provide a link to the Creative Commons license, coronary intervention in patients with insulin- and indicate if changes were made. treated and non-insulin-treated diabetes mellitus: secondary analysis of the TUXEDO trial. JAMA Cardiol. 2016;1(3):266–73. 11. Banning AP, Westaby S, Morice MC, et al. Diabetic REFERENCES and nondiabetic patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-elut- 1. Danaei G, Finucane MM, Lu Y, et al. National, ing stents. J Am Coll Cardiol. 2010;55(11):1067–75. regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic 12. Dangas GD, Farkouh ME, Sleeper LA, et al. Long- analysis of health examination surveys and epi- term outcome of PCI versus CABG in insulin and demiological studies with 370 country-years and 2.7 non-insulin-treated diabetic patients: results from million participants. Lancet. 2011;378(9785):31–40. the FREEDOM trial. J Am Coll Cardiol. 2014;64(12):1189–97. 2. World Health Organization. Global health risks: mortality and burden of disease attributable to 13. Jain AK, Lotan C, Meredith IT, et al. Twelve-month selected major risks. Geneva: World Health Orga- outcomes in patients with diabetes implanted with nization; 2009. a zotarolimus-eluting stent: results from the E-Five Registry. Heart. 2010;96(11):848–53. 3. Schnell O, Standl E, Catrinoiu D, et al. Report from the 2nd Cardiovascular Outcome Trial (CVOT) Diabetes Ther (2018) 9:1335–1345 1345 14. Kappetein AP, Head SJ, Morice MC, et al. Treatment 19. Simsek C, Ra¨ber L, Magro M, et al. Long-term out- of complex coronary artery disease in patients with come of the unrestricted use of everolimus-eluting diabetes: 5-year results comparingoutcomes of stents compared to sirolimus-eluting stents and bypass surgery and percutaneous coronary inter- paclitaxel-eluting stents in diabetic patients: the vention in the SYNTAX trial. Eur J Cardiothorac Bern–Rotterdam diabetes cohort study. Int J Car- Surg. 2013;43(5):1006–13. diol. 2013;170(1):36–42. 15. Kirtane AJ, Ellis SG, Dawkins KD, et al. Paclitaxel- 20. Tada T, Kimura T, Morimoto T, et al. Comparison of eluting coronary stents in patients with diabetes three year clinical outcomes after sirolimus eluting mellitus: pooled analysis from 5 randomized trials. stent implantation among insulin-treateddiabetic, J Am Coll Cardiol. 2008;51(7):708–15. non-insulin-treated diabetic, and non-diabetic patients from J-Cypher registry. Am J Cardiol. 16. Kirtane AJ, Patel R, O’Shaughnessy C, et al. Clinical 2011;107(8):1155–62. and angiographic outcomes in diabetics from the ENDEAVOR IV trial: randomized comparison of 21. Zhu M, Li J, Li Z, et al. Mortality rates and the causes of zotarolimus- and paclitaxel-eluting stents in death related to diabetes mellitus in Shanghai Song- patients with coronary artery disease. JACC Car- jiang District: an 11-year retrospective analysis of diovasc Interv. 2009;2(10):967–76. death certificates. BMC Endocr Disord. 2015;15:45. 17. Mehran R, Dangas GD, Kobayashi Y, et al. Short- 22. Bundhun PK, Wu ZJ, Chen MH. Coronary artery and long-term results after multivessel stenting in bypass surgery compared with percutaneous coro- diabetic patients. J Am Coll Cardiol. nary interventions in patients with insulin-treated 2004;43(8):1348–54. type 2 diabetes mellitus: a systematic review and meta-analysis of 6 randomized controlled trials. 18. Nakamura M, Yokoi H, Hamazaki Y, et al. Impact of Cardiovasc Diabetol. 2016;6(15):2. insulin-treated diabetes and hemodialysis on long- term clinical outcomes following sirolimus-elut- 23. Bundhun PK, Pursun M, Huang F. Are women with ingstent deployment. Insights from a sub-study of type 2 diabetes mellitus more susceptible to car- the Cypher Stent Japan Post-Marketing Surveillance diovascular complications following coronary (Cypher J-PMS) Registry. Circ J. angioplasty?: a meta-analysis. BMC Cardiovasc 2010;74(12):2592–97. Disord. 2017;17(1):207. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Diabetes Therapy Springer Journals

Cardiac Versus Non-Cardiac Related Mortality Following Percutaneous Coronary Intervention in Patients with Insulin-Treated Type 2 Diabetes Mellitus: A Meta-Analysis

Free
11 pages
Loading next page...
 
/lp/springer_journal/cardiac-versus-non-cardiac-related-mortality-following-percutaneous-oUPmnDpf8h
Publisher
Springer Healthcare
Copyright
Copyright © 2018 by The Author(s)
Subject
Medicine & Public Health; Internal Medicine; Diabetes; Cardiology; Endocrinology
ISSN
1869-6953
eISSN
1869-6961
D.O.I.
10.1007/s13300-018-0444-y
Publisher site
See Article on Publisher Site

Abstract

Diabetes Ther (2018) 9:1335–1345 https://doi.org/10.1007/s13300-018-0444-y ORIGINAL RESEARCH Cardiac Versus Non-Cardiac Related Mortality Following Percutaneous Coronary Intervention in Patients with Insulin-Treated Type 2 Diabetes Mellitus: A Meta-Analysis . . Qiang Wang Hao Liu Jiawang Ding Received: April 26, 2018 / Published online: May 19, 2018 The Author(s) 2018 carried out using RevMan version 5.3 software, ABSTRACT and data were reported with odds ratios (OR) and 95% confidence intervals (CI) as the main Introduction: Cardiovascular mortality is a parameters. major concern for patients with type 2 diabetes Results: A total of 4072 participants with ITDM mellitus (T2DM). Insulin therapy significantly were included, of whom 1658 participants and contributes to a high rate of death in these 2414 participants were extracted from random- patients. We have performed a meta-analysis ized controlled trials and observational cohorts, comparing cardiac and non-cardiac-related respectively. Analysis of all data showed that mortality following percutaneous coronary death due to cardiac causes was significantly intervention (PCI) in a sample of patients with higher in patients with ITDM (OR 2.16, 95% CI insulin-treated type 2 diabetes mellitus (ITDM). 1.79–2.59; P = 0.00001). At 1 year of follow-up, Methods: Studies were included in the meta- cardiac death was still significantly higher analysis if: (1) they were trials or cohort studies compared to non-cardiac death (OR 2.39, 95% involving patients with T2DM post-PCI; (2) the CI 1.47–3.88; P = 0.0004), and this result did outcomes in ITDM were separately reported; not change with a longer follow-up period (3–- and (3) they reported cardiac death and non- 5 years) (OR 2.09, 95% CI 1.70–2.56; cardiac death among their clinical endpoints. P = 0.00001). Death due to cardiac causes was ITDM patients with any degree of coronary still significantly higher in the subpopulations artery disease were included. The analysis was of patients with everolimus-eluting stents (OR 2.31, 95% CI 1.26–4.26; P = 0.007), paclitaxel- Enhanced digital features To view enhanced digital eluting stents (OR 2.36, 95% CI 1.63–3.39; features for this article go to https://doi.org/10.6084/ P = 0.00001), sirolimus-eluting stents (OR 2.11, m9.figshare.6247415. 95% CI 1.67–2.67; P = 0.00001), and zotar- olimus-eluting stents (OR 2.12, 95% CI Q. Wang  J. Ding (&) 1.11–4.05; P = 0.02), respectively. Institute of Cardiovascular Diseases, Yichang Central People’s Hospital, Yichang 443000, Hubei, Conclusions: Mortality due to cardiac causes People’s Republic of China was significantly higher than that due to non- e-mail: 183246397@qq.com cardiac causes in patients with ITDM who had H. Liu undergone PCI. The same conclusion could be Institute of Cardiovascular Diseases, The Second drawn from analyses focused on different fol- Affiliated Hospital of Guangxi Medical University, low-up periods, types of coronary stents, and Nanning 530021, Guangxi, People’s Republic of type of study data used. China 1336 Diabetes Ther (2018) 9:1335–1345 words/index terms were used to identify articles Keywords: Cardiovascular disease; Cardiac mortality; Insulin-treated type 2 diabetes of possible interest: – T2DM ? PCI, or mellitus; Non-cardiac mortality; Percutaneous – T2DM ? coronary angioplasty, or coronary intervention – T2DM ? PCI, or – ITDM ? PCI, or INTRODUCTION – Cardiac death ? ITDM ? PCI. In this era of modern medicine, nearly three Inclusion and Exclusion Criteria hundred and fifty million cases of diabetes have been diagnosed to date worldwide [1]. Mortality Studies were included in the meta-analysis is a great concern among this patient popula- review if: (1) they were trials or cohort studies tion, especially in those with type 2 diabetes based on patients with T2DM following PCI; (2) mellitus (T2DM) in co-existence with cardio- they separately reported outcomes in patients vascular disease (CVD). Values calculated by the with ITDM; (3) they reported cardiac death and World Health Organization show that there are non-cardiac death among their endpoints. approximately three million deaths annually Studies were excluded from the systematic due to T2DM and its related complications [2]. review if: (1) they did not involve patients with Cardiovascular mortality, which was evaluated T2DM following PCI; (2) they did not separately in the Second Cardiovascular Outcome Trial report patients with ITDM; (3) they did not report Summit of the Diabetes and Cardiovascular cardiac death among their clinical outcomes; (4) Disease (D&CVD) EASD Study Group [3], is also they were repeated studies or duplicate studies. a major health risk factor in the population of patients with T2DM. Participants T2DM is an independent cause of mortality. Although data from the Korean National Health All participants in the studies ultimately inclu- Insurance Service–National Sample Cohort ded in our systematic review were patients with showed that 78% of diabetes-related deaths ITDM. However, the extent of the coronary could not be ascribed to diabetes [4], other artery disease varied among studies and inclu- studies have shown that in T2DM patients with ded ITDM patients with stable coronary artery CVD who were re-vascularized by percutaneous disease, de novo coronary artery disease, acute coronary intervention (PCI), insulin therapy myocardial infarction, single-vessel coronary significantly contributed to a high death rate [5]. artery disease, multi-vessel coronary artery dis- We have therefore conducted a meta-analy- ease (Table 1). sis to compare cardiac- versus non-cardiac-re- lated mortalityfollowing PCI in a sample of patients with insulin-treatedtype 2 diabetes Definition of Endpoints mellitus (ITDM). To date, few studies have sys- tematically assessed cardiac versus non-cardiac In this analysis, cardiac death was compared mortality in such patients following PCI. with non-cardiac death in diabetic patients who received insulin treatment. Therefore, the main focus was on: (1) cardiac mortality: death due to METHODS cardiac causes; (2) non-cardiac mortality: death which was not related to cardiac causes. Searched Databases and Key Words/Index Terms Data Extraction and Review We systematically and thoroughly searched the The following data were extracted by three MEDLINE/PubMed, EMBASE, Cochrane library, reviewers independently of each other: (1) and Google Scholar databases. the following key Diabetes Ther (2018) 9:1335–1345 1337 Table 1 Participants with insulin-treatedtype 2 diabetes mellitus and coronary artery disease participating in the studies included in the systematic review First author/year/reference of studies Coronary artery disease status of study participants Diabetes status of included in the meta-analysis study participants Antoniucci 2004 [9] Acute myocardial infarction ITDM Bangalore 2016 [10] Stable coronary artery disease ITDM Banning 2010 [11] Left main and/or three-vessel coronary artery disease ITDM Dangas 2014 [12] Multiple-vessel coronary artery disease ITDM Jain 2010 [13] Single- or multi-vessel coronary artery disease ITDM Kappetein 2013 [14] Complex coronary artery disease: de novo three-vessel ITDM and/or left main coronary artery disease Kirtane 2008 [15] Single de novo lesion in a native coronary artery ITDM Kirtane 2009 [16] Stable coronary artery disease ITDM Mehran 2004 [17] Multi-vessel coronary artery disease ITDM Nakamura 2010 [18] Coronary artery disease ITDM Simek 2013 [19] All corner patients with coronary artery disease ITDM Tada 2011 [20] Coronary artery disease ITDM ITDM insulin-treated type 2 diabetes mellitus patients with ITDM; (2) the number of events test (the lower the value, the lower the corresponding to cardiac death; (3) the number heterogeneity). of events corresponding to non-cardiac death; A fixed (I \ 50%) effects model or a random (4) baseline features; (5) methodological fea- (I [ 50%) model was used based on the value tures of each study; (5) type of study. of I that was obtained. The methodological qualities for the ran- domized controlled trials were assessed by using Compliance with Ethics Guidelines the guidelines set down in the Cochrane Handbook for Systematic Reviews of Interven- This meta-analysis is based on previously con- tions [6]. The Newcastle–Ottawa Scale (NOS) [7] ducted studies and does not contain any studies was used to assess the methodological qualities with human participants or animals performed for the observational studies. by any of the authors. Statistical Analysis RESULTS The computer program RevMan version 5.3 Searched Outcomes (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) was used as analytical software. Odds ratios (ORs) We followed the PRISMA guideline for this analysis [8]. with 95% confidence intervals (CIs) were cal- culated. Heterogeneity was assessed by two A total of 1368 publications were identified from the database search using the chosen key meta-analytical methods: (1) The Cochrane Q statistic test (a P value of B 0.05 indicates a words/index terms. Publications were excluded and eliminated based on the following criteria: statistically significant result); (2) the I statistic 1338 Diabetes Ther (2018) 9:1335–1345 – They were not related to the aim of this eluting stents DES, specifically everolimus-elut- meta-analysis (n = 1282). ing stents (EES), paclitaxel-eluting stents (PES), – They did not report cardiovascular death, sirolimus-eluting stents (SES), and zotarolimus- but instead reported total death among their eluting stents (ZES), as shown in Table 2. clinical outcomes (n = 12). The baseline features of the participants with – They were meta-analyses or review articles ITDM are given in Table 3. Based on the features themselves (n = 5). which are listed, there was no significant dif- – They did not separately report patients with ference between those patients who died due to ITDM (n = 21). a cardiac cause and those who died due to a – They were duplicates of the same study non-cardiac cause. (n = 36). The methodological qualities of the studies Ultimately, a total number of 12 articles (6 were also assessed. RCTs were assessed with the randomized controlled trials [RCTs] and 6 recommended features of the Cochrane collab- observational cohorts) [9–20] were included in oration guidelines [6]. Grades were given to this meta-analysis, as shown in Fig. 1. define the limit of bias (low, low to moderate, moderate, and high). For the observational studies, NOS scores [7] were given, with a General and Baseline Features maximum number of nine points (a higher of the Participants score indicates better quality study), as shown in Table 4. A total number of 4072 patients with ITDM who participated in 12 observational studies/RCTs Death Due to Cardiac Versus Non-cardiac were included in this meta-analysis. Of these, Causes Following PCI in Patients 1658 participants were extracted from RCTs and with ITDM 2414 participants were extracted from observa- tional studies. Two studies had a follow-up period of \ 1 year, four studies had a follow-up Analysis of the combined data extracted from period of 1 year, and six studies had a follow-up the included RCTs and observational studies period of [ 1 [range 3–5] year). One study revealed that death due to cardiac causes was reported patients who were treated with a bare significantly higher in patients with ITDM than metal stent, whereas all of the other studies death due to non-cardiac causes(OR 2.16, 95% involved patients who were treated with drug- Fig. 1 Flow diagram of study selection. ITDM Insulin-treated type 2 diabetes mellitus Diabetes Ther (2018) 9:1335–1345 1339 Table 2 Total number of events and other features of the studies included in the meta-analysis First author/year/ Type of Number of Number of Total Duration Type of stent reference of studies study patients with patients number of of follow- included in the cardiac with non- patients up period meta-analysis death cardiac death Antoniucci 2004 [9] Observational 16 6 84 6 months – Bangalore 2016 [10] RCT 18 8 747 1 year PES, EES Banning 2010 [11] RCT 9 2 88 1 year PES Dangas 2014 [12] RCT 42 20 325 5 years DES (SES and PES) Jain 2010 [13] Observational 29 14 644 1 year ZES Kappetein 2013 [14] RCT 16 5 89 5 years PES Kirtane 2008 [15] RCT 15 13 265 4 years PES, BMS Kirtane 2009 [16] RCT 0 0 144 1 year ZES, PES Mehran 2004 [17] Observational 1 1 81 In-hospital – Nakamura 2010 Observational 13 10 200 3 years SES [18] Simek 2013 [19] Observational 63 25 489 3 years EES, SES, PES Tada 2011 [20] Observational 149 80 996 3 years SES RCT randomized controlled trials, BMS bare metal stent, SES sirolimus eluting stents, DES drug eluting stents, ZES zotarolimus eluting stents, EES everolimus eluting stents, PES paclitaxel eluting stents CI 1.79–2.59; P = 0.00001; I = 0%) when higher in these patients with ITDM (OR 2.09, (Fig. 2). 95% CI 1.70–2.56; P = 0.00001; I = 15%) However, data from RCTs and observational (Fig. 6). studies were also analyzed separately. When we When the participants were analyzed based considered only data obtained from RCTs in the on the type of stents, death due to cardiac analysis, death from cardiac causes was still causes was still significantly higher in those significantly higher in patients with ITDM (OR patients having an EES (OR 2.31, 95% CI 2 2 2.20, 95% CI 1.54–3.14; P = 0.0001; I = 14%) 1.26–4.26; P = 0.007, I = 0%) compared to (Fig. 3).Similarly, when we considered only data those a PES (OR 2.36, 95% CI 1.63–3.39; obtained from observational cohorts, death due P = 0.00001; I = 0%), SES (OR 2.11, 95% CI to cardiac causes was significantly higher in the 1.67–2.67; P = 0.00001; I = 21%), or ZES (OR ITDM patients (OR 2.14, 95% CI 1.73–2.66; 2.12, 95% CI 1.11–4.05; P = 0.02), as shown in P = 0.00001; I = 0%) (Fig. 4). Fig. 7. When all the studies with a follow-up period of 1 year were analyzed together, cardiac death DISCUSSION was still significantly higher in patients with ITDM compared to non-cardiac death (OR 2.39, Cardiovascular death is a major concern among 95% CI 1.47–3.88; P = 0.0004; I = 0%) (Fig. 5). patients with T2DM who are treated by PCI. The When studies with longer follow-up periods results of our meta-analysis show that cardio- were considered (range 3–5 years), mortality vascular death in patients with ITDM who have due to cardiac causes was still significantly 1340 Diabetes Ther (2018) 9:1335–1345 Table 3 Baseline features of the participants First author/year/reference Age (years) Males (%) Hypertension Dyslipidemia Current Body mass of studies included in the (%) (%) smoker (%) index (kg/ meta-analysis m ) CD NCD CD NCD CD NCD CD NCD CD NCD CD NCD Antoniucci 2004 [9] 69.0 69.0 65.0 65.0 40.0 40.0 30.0 30.0 20.0 20.0 – - Bangalore 2016 [10] 58.5 58.5 71.0 71.0 65.6 65.6 76.2/ 76.2 12.3 12.3 26.1 26.1 Banning 2010 [11] 65.4 65.4 71.0 71.0 69.9 69.9 81.5 81.5 15.8 15.8 29.5 29.5 Dangas 2014 [12] 62.6 62.6 61.3 61.3 87.5 87.5 – - 17.9 17.9 30.5 30.5 Jain 2010 [13] 66.6 66.6 62.2 62.2 82.1 82.1 67.9 67.9 13.9 13.9 – - Kappetein 2013 [14] 65.4 65.4 71.0 71.0 70.0 70.0 82.0 82.0 16.0 16.0 29.5 29.5 Kirtane 2008 [15] 63.0 63.0 64.7 64.7 82.1 82.1 74.0 74.0 18.4 18.4 – - Kirtane 2009 [16] 63.3 63.3 71.0 71.0 76.7 76.7 81.4 81.4 64.8 64.8 – - Mehran 2004 [17] 63.0 63.0 52.0 52.0 77.0 77.0 71.0 71.0 11.0 11.0 – - Nakamura 2010 [18] 66.2 66.2 66.2 66.2 68.1 68.1 58.0 58.0 12.1 12.1 24.0 24.0 Simek 2013 [19] 65.1 65.1 69.2 69.2 70.6 70.6 65.5 65.5 32.1 32.1 28.8 28.8 Tada 2011 [20] 66.7 66.7 67.0 67.0 76.0 76.0 – - 16.0 16.0 24.1 24.1 CD Cardiac death, NCD non-cardiac death undergone PCI was significantly higher that An 11-year retrospective analysis of death death due to non-cardiac causes. This result certificates in Shanghai also showed an remained consistent even when data from the increasing occurrence of CVD among Chinese RCTs and observational studies were analyzed patients who had previously developed diabetes separately. mellitus [21], with 29.9% of deaths among To assess the effect of differences in follow- those diabetic patients due to cardiovascular up periods on the cause of death in this patient causes; in comparison, other causes represented group, we also separately analyzed the data only small percentages. However, causes of from all of the studies included in the meta- death based specifically on patients with ITDM analysis which reported a follow-up period of were not analyzed in that study. 1 year. As reported in the ‘‘Results’’ section, Finally, even though research has shown cardiac death was still significantly higher in diabetes mellitus to be independently associ- this subpopulation of patients with ITDM. ated with death due to CVD, other studies have When a longer follow-up period (3–5 years) was shown that insulin therapy also makes a major considered, the major cause of death remained contribution to such an outcome [5, 22]. In cardiovascular. addition, female gender and higher co-mor- We also assessed the impact of coronary bidities have also been suggested to further stents on the results by analyzed the data from contribute to such outcomes [23]. These factors all studies based on the types of coronary stents should further be investigated in future studies. which were implanted (EES, PES, SES, and ZES). There are a few limitations to our analysis. However, cardiovascular cause of death was still First, the total number of patients was relatively significantly higher in the patients with ITDM. small, especially for the analysis on impact of Diabetes Ther (2018) 9:1335–1345 1341 Table 4 Assessment of bias risk First author/year/reference of studies included in the meta-analysis Bias risk grade/score Bias status RCTs (Cochrane assessment) Kirtane 2009 [16] B Low to moderate Bangalore 2016 [10] A Low Banning 2010 [11] A Low Dangas 2014 [12] A Low Kirtane 2008 [15] B Low to moderate Kappetein 2013 [14] B Low to moderate Observational studies (NOS assessment) Antoniucci 2004 [9] 6 Moderate Jain 2010 [13] 8 Low Mehran 2004 [17] 6 Moderate Nakamura 2010 [18] 6 Moderate Simek 2013 [19] 7 Low Tada 2011 [20] 6 Moderate NOS Newcastle–Ottawa Scale Fig. 2 Cardiac versus non-cardiac death following percutaneous coronary intervention (PCI) in patients with ITDM. CI Confidence interval, M–H Mantel–Haenszel test types of coronary stents on cause of death in artery disease, left main coronary artery disease, patients with ITDM treated by PCI. Second, data and acute myocardial infarction) were com- from different categories of participants (those bined and analyzed. Third, the anti-platelet with stable coronary artery disease, multi-vessel agents which were used post-PCI were not taken coronary artery disease, single-vessel coronary 1342 Diabetes Ther (2018) 9:1335–1345 Fig. 3 Cardiac versus non-cardiac death following PCI in patients with ITDM based only on data obtained from randomized controlled trials Fig. 4 Cardiac versus non-cardiac death following PCI in ITDM based only on data obtained from observational cohorts Fig. 5 Cardiac versus non-cardiac death following PCI in ITDM during a follow-up period of 1 year Fig. 6 Cardiac versus non-cardiac death following PCI in ITDM during a longer follow-up period (range 3–5 years) Diabetes Ther (2018) 9:1335–1345 1343 Fig. 7 Cardiac versus non-cardiac death following PCI in ITDM according to drug-eluting stents into consideration and this might also have had ACKNOWLEDGEMENTS an impact on the mortality rate. Funding. No funding or sponsorship was CONCLUSIONS received for this study or publication of this article. In patients with ITDM, mortality due to cardiac causes was significantly higher than that due to Authorship. All named authors meet the non-cardiac causes following PCI. The same International Committee of Medical Journal conclusion was reached when different lengths Editors (ICMJE) criteria for authorship for this of follow-up periods were assessed, when dif- article, take responsibility for the integrity of ferent data sets were used (total data set, data the work as a whole, and have given their from the observational cohort or RCTs sepa- approval for this version to be published. rately), and when types of coronary stents which were implanted were assessed. 1344 Diabetes Ther (2018) 9:1335–1345 Summit of the Diabetes and Cardiovascular Disease Authorship Contributions. Qiang Wang, (D&CVD) EASD Study Group. Cardiovasc Diabetol. Hao Liu, and Jiawang Ding were responsible for 2017;16(1):35. the conception and design, acquisition of data, analysis and interpretation of data, drafting the 4. Kang YM, Kim YJ, Park JY, Lee WJ, Jung CH. Mor- tality and causes of death in a national sample of initial manuscript, and critical revision of the type 2 diabetic patients in Korea from 2002 to 2013. manuscript for important intellectual content. Cardiovasc Diabetol. 2016;15(1):131. Qiang Wang wrote the manuscript and is the first author. 5. Bundhun PK, Li N, Chen MH. Adverse cardiovas- cular outcomes between insulin-treated and non- insulin treated diabetic patients after percutaneous Disclosures. The authors Qiang Wang, Hao coronary intervention: a systematic review and Liu and Jiawang Ding have nothing to disclose. meta-analysis. Cardiovasc Diabetol. 2015;14:135. They do not have any personal, financial, commercial, or academic conflicts of interest. 6. Higgins JP, Thompson SG, Deeks JJ, et al. Assessing risk of bias in included studies. In: Cochrane handbook for systematic reviews of interventions. Compliance with Ethics Guidelines. This Wiley; 2008. p. 187–241. meta-analysis is based on previously conducted studies and does not contain any studies with 7. Wells GA, Shea B, O’Connell D, et al. The New- human participants or animals performed by castle–Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. 2009. any of the authors. http://www.ohri.ca/programs/clinical_ epidemiology/oxford.htm. Accessed 19 Oct 2009. Data Availability. All data generated or analyzed during this study are included in this 8. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and published article. meta-analyses of studies that evaluate health- careinterventions: explanation and elaboration. Open Access. This article is distributed BMJ. 2009;339:b2700. under the terms of the Creative Commons Attribution-NonCommercial 4.0 International 9. Antoniucci D, Valenti R, Migliorini A, et al. Impact of insulin requiring diabetes mellitus on effective- License (http://creativecommons.org/licenses/ ness of reperfusion and outcome of patients by-nc/4.0/), which permits any non- undergoing primary percutaneous coronary inter- commercial use, distribution, and reproduction vention for acute myocardial infarction. Am J Car- in any medium, provided you give appropriate diol. 2004;93(9):1170–72. credit to the original author(s) and the source, 10. Bangalore S, Bhagwat A, Pinto B, et al. Percutaneous provide a link to the Creative Commons license, coronary intervention in patients with insulin- and indicate if changes were made. treated and non-insulin-treated diabetes mellitus: secondary analysis of the TUXEDO trial. JAMA Cardiol. 2016;1(3):266–73. 11. Banning AP, Westaby S, Morice MC, et al. Diabetic REFERENCES and nondiabetic patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-elut- 1. Danaei G, Finucane MM, Lu Y, et al. National, ing stents. J Am Coll Cardiol. 2010;55(11):1067–75. regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic 12. Dangas GD, Farkouh ME, Sleeper LA, et al. Long- analysis of health examination surveys and epi- term outcome of PCI versus CABG in insulin and demiological studies with 370 country-years and 2.7 non-insulin-treated diabetic patients: results from million participants. Lancet. 2011;378(9785):31–40. the FREEDOM trial. J Am Coll Cardiol. 2014;64(12):1189–97. 2. World Health Organization. Global health risks: mortality and burden of disease attributable to 13. Jain AK, Lotan C, Meredith IT, et al. Twelve-month selected major risks. Geneva: World Health Orga- outcomes in patients with diabetes implanted with nization; 2009. a zotarolimus-eluting stent: results from the E-Five Registry. Heart. 2010;96(11):848–53. 3. Schnell O, Standl E, Catrinoiu D, et al. Report from the 2nd Cardiovascular Outcome Trial (CVOT) Diabetes Ther (2018) 9:1335–1345 1345 14. Kappetein AP, Head SJ, Morice MC, et al. Treatment 19. Simsek C, Ra¨ber L, Magro M, et al. Long-term out- of complex coronary artery disease in patients with come of the unrestricted use of everolimus-eluting diabetes: 5-year results comparingoutcomes of stents compared to sirolimus-eluting stents and bypass surgery and percutaneous coronary inter- paclitaxel-eluting stents in diabetic patients: the vention in the SYNTAX trial. Eur J Cardiothorac Bern–Rotterdam diabetes cohort study. Int J Car- Surg. 2013;43(5):1006–13. diol. 2013;170(1):36–42. 15. Kirtane AJ, Ellis SG, Dawkins KD, et al. Paclitaxel- 20. Tada T, Kimura T, Morimoto T, et al. Comparison of eluting coronary stents in patients with diabetes three year clinical outcomes after sirolimus eluting mellitus: pooled analysis from 5 randomized trials. stent implantation among insulin-treateddiabetic, J Am Coll Cardiol. 2008;51(7):708–15. non-insulin-treated diabetic, and non-diabetic patients from J-Cypher registry. Am J Cardiol. 16. Kirtane AJ, Patel R, O’Shaughnessy C, et al. Clinical 2011;107(8):1155–62. and angiographic outcomes in diabetics from the ENDEAVOR IV trial: randomized comparison of 21. Zhu M, Li J, Li Z, et al. Mortality rates and the causes of zotarolimus- and paclitaxel-eluting stents in death related to diabetes mellitus in Shanghai Song- patients with coronary artery disease. JACC Car- jiang District: an 11-year retrospective analysis of diovasc Interv. 2009;2(10):967–76. death certificates. BMC Endocr Disord. 2015;15:45. 17. Mehran R, Dangas GD, Kobayashi Y, et al. Short- 22. Bundhun PK, Wu ZJ, Chen MH. Coronary artery and long-term results after multivessel stenting in bypass surgery compared with percutaneous coro- diabetic patients. J Am Coll Cardiol. nary interventions in patients with insulin-treated 2004;43(8):1348–54. type 2 diabetes mellitus: a systematic review and meta-analysis of 6 randomized controlled trials. 18. Nakamura M, Yokoi H, Hamazaki Y, et al. Impact of Cardiovasc Diabetol. 2016;6(15):2. insulin-treated diabetes and hemodialysis on long- term clinical outcomes following sirolimus-elut- 23. Bundhun PK, Pursun M, Huang F. Are women with ingstent deployment. Insights from a sub-study of type 2 diabetes mellitus more susceptible to car- the Cypher Stent Japan Post-Marketing Surveillance diovascular complications following coronary (Cypher J-PMS) Registry. Circ J. angioplasty?: a meta-analysis. BMC Cardiovasc 2010;74(12):2592–97. Disord. 2017;17(1):207.

Journal

Diabetes TherapySpringer Journals

Published: May 19, 2018

References

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off