Impact of diabetes and hypertension on cardiovascular outcomes in patients with coronary artery disease receiving percutaneous coronary intervention

Abstract

BackgroundPercutaneous coronary intervention (PCI) is a necessary procedure commonly performed for patients with coronary artery disease (CAD). However, the impact of diabetes and hypertension on long-term outcomes of patients after receiving PCI has not yet been determined.MethodsThe data of 1234 patients who received PCI were collected prospectively, and patients were divided into four groups, including patients with and without DM and those with either DM or hypertension alone. Baseline characteristics, risk factors, medications and angiographic findings were compared and determinants of cardiovascular outcomes were analyzed in patients who received PCI.ResultsPatients with DM alone had the highest all-cause mortality (P < 0.001), cardiovascular mortality and myocardial infarctions (MI) (both P < 0.01) compared to the other groups. However, no differences were found between groups in repeat PCI (P = 0.32). Cox proportional hazard model revealed that age, chronic kidney disease (CKD), previous MI and stroke history were risk factors for all-cause mortality (OR: 1.05,1.89, 2.87, and 4.12, respectively), and use of beta-blockers (BB) and statins reduced all-cause mortality (OR: 0.47 and 0.35, respectively). Previous MI and stroke history, P2Y12 inhibitor use, and syntax scores all predicted CV mortality (OR: 4.02, 1.89, 2.87, and 1.04, respectively). Use of angiotensin converting enzyme inhibitors (ACEI), beta-blockers (BB), and statins appeared to reduce risk of CV death (OR: 0.37, 0.33, and 0.32, respectively). Previous MI and syntax scores predicted MI (OR: 3.17 and 1.03, respectively), and statin use reduced risk of MI (OR: 0.43). Smoking and BB use were associated with repeat PCI (OR: 1.48 and 1.56, respectively).ConclusionsAfter PCI, patients with DM alone have higher mortality compared to patients without DM and hypertension, with both DM and hypertension, and with hypertension alone. Comorbid hypertension does not appear to increase risk in DM patients, whereas comorbid DM appears to increase risk in hypertensive patients.Trial registrationREC103-15 IRB of Taichung Tzu-chi Hospital

Determinants of angiographic thrombus burden and impact of thrombus aspiration on outcome in young patients with ST‐segment elevation myocardial infarction

“…Previous study found that the prevalence of hypertension was 25% in young CAD patients as compared with 13% in comparable age group without CAD, and the prevalence of hypertension was much higher in elderly CAD individuals as compared with young CAD patients . Several studies also reported an increasing trend of the prevalence of hypertension in young CAD patients . Our results indicate that the prevalence of hypertension is significantly higher in patients with HTB than in patients with LTB (75.0 vs. 17.1%, P < 0.001).…”

“…36 Several studies also reported an increasing trend of the prevalence of hypertension in young CAD patients. 36,37 Our results indicate that the prevalence of hypertension is significantly higher in patients with HTB than in patients with LTB (75.0 vs. 17.1%, P < 0.001). Moreover, the multiple logistic regression analysis results revealed that hypertension remained as a significant independent risk factor for higher TB after adjustment for age, gender, and body mass index.…”

Chronic kidney disease and diabetes associated with long-term outcomes in patients receiving percutaneous coronary intervention

“…Combined DM and CKD seemed to have an additive effect on the progression of atherosclerosis and development of multi-vessel disease than patients with isolated DM or isolated CKD. This is in contrast to a previous study that they observed patients with both DM and hypertension did not have a significant risk of developing multi-vessel disease, as compared with patients with DM alone [ 21 ]. However, in terms of treated numbers of the vessels and lesions, no difference existed among patients with DM alone, CKD alone, or both DM and CKD ( P = NS); thus, dominance of multi-vessel disease and poor left ventricular function in patients with DM and CKD may affect long-term outcomes in the present study.…”

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“…The past history of diabetes and hypertension are obviously risk factors of ACS (p value <0.05). It is well established that diabetes mellitus is an independent predictor of adverse cardiovascular events, regardless of age [12][13] . In this study smoking has significant association with acute coronary syndrome.…”