National trends in utilization and outcomes of coronary revascularization procedures among people with and without type 2 diabetes in Spain (2001–2011)

Abstract

BackgroundDiabetes is associated with a high risk of death due to coronary artery disease (CAD). People with diabetes suffering from CAD are frequently treated with revascularization procedures. We aim to compare trends in the use and outcomes of coronary revascularization procedures in diabetic and non-diabetic patients in Spain between 2001 and 2011.MethodsWe identified all patients who had undergone coronary revascularization procedures, percutaneous coronary interventions (PCI) and coronary artery bypass graft (CABG) surgeries, using national hospital discharge data. Discharges were grouped by diabetes status: type 2 diabetes and no diabetes. The incidence of discharges attributed to coronary revascularization procedures were calculated stratified by diabetes status. We calculated length of stay and in-hospital mortality (IHM). We apply joinpoint log-linear regression to identify the years in which changes in tendency occurred in the use of PCI and CABG in diabetic and non-diabetic patients. Multivariate analysis was adjusted by age, sex, year and comorbidity (Charlson comorbidity index).ResultsFrom 2001 to 2011, 434,108 PCIs and 79,986 CABGs were performed. According to the results of the joinpoint analysis, we found that sex and age-adjusted use of PCI increased by 31.4% per year from 2001 to 2003, by 15.9% per year from 2003 to 2006 and by 3.8% per year from 2006 to 2011 in patients with diabetes. IHM among patients with diabetes who underwent a PCI did not change significantly over the entire study period (OR 0.99; 95% CI 0.97-1.00).Among patients with diabetes who underwent a CABG, the sex and age-adjusted CABG incidence rate increased by 10.4% per year from 2001 to 2003, and then decreased by 1.1% through 2011. Diabetic patients who underwent a CABG had a 0.67 (95% CI 0.63-0.71) times lower probability of dying during hospitalization than those without diabetes.ConclusionsThe annual percent change in PCI procedures increased in diabetic and non-diabetic patients. Higher comorbidity and the female gender are associated with a higher IHM in PCI procedures. In diabetic and non-diabetic patients, we found a decrease in the use of CABG procedures. IHM was higher in patients without diabetes than in those with diabetes.

Improved trends in cardiovascular complications among subjects with type 2 diabetes in Korea: a nationwide study (2006–2013)

“…The relative statistically significant increase was observed in men regardless of the presence of diabetes as well as in non-diabetic adults aged <65 years and all adults aged ≥65 years regardless of the presence of diabetes (Table 5). This result is in accordance with those of other studies [26, 36], in which the PCI rate significantly increased due to marked advances in stent technology, such as the introduction of drug-eluting stents and adjunctive pharmacology [26, 36]. Although CABG offers more advantages in terms of survival and the need for repeat revascularization for patients with severe forms of coronary artery disease, particularly patients with diabetes [26], the aforementioned technological advances in PCI might have contributed to the shift from CABG to PCI in subjects with diabetes, as in individuals without diabetes.…”

The influence of Elixhauser comorbidity index on percutaneous coronary intervention outcomes

“…Additionally, our study provides an insight into how comorbid states influence health economics and hospital stay. This confirms a smaller Spanish study of 434,108 PCIs demonstrating that another measure of comorbid burden, the Charlson comorbidity index, was an independent predictor of mortality, stent thrombosis and major adverse cardiovascular events.…”

“…An increasingly elderly population of patients with significant comorbid burden and complex coronary disease are undergoing coronary revascularization due to more effective treatments, better stent designs, and advancements in interventional techniques and coronary imaging. [15][16][17][18][19] While the association between individual cardiovascular comorbid conditions and clinical outcomes following PCI has been extensively studied, noncardiovascular comorbidity is often not captured in PCI datasets. This is particularly relevant given that many noncardiovascular comorbid conditions such as cancer 20 or chronic in in-hospital mortality.…”

Prevalence and Impact of Co-morbidity Burden as Defined by the Charlson Co-morbidity Index on 30-Day and 1- and 5-Year Outcomes After Coronary Stent Implantation (from the Nobori-2 Study)

“…National data from Spain over a 10-year period (2001 to 2011) have documented that the average age of patients with and without diabetes who underwent PCI has increased by an average of 2 years, whereas the proportion of patients with no co-morbid conditions has decreased significantly over the same time frame. 2 In contemporary studies, a significant proportion of patients with coronary heart disease have a significant burden of co-morbidities with over half of the patients reported as having at least 1 comorbid condition in a number of studies. 5,6 The 4 most prevalent co-morbid conditions identified in our cohort were risk factors for, or manifestations of coronary artery disease, including previous acute myocardial infarction (33.2%), diabetes (29.5%), peripheral vascular disease (6.6%), and previous cerebrovascular accident (CVA) (4.4%), whereas other co-morbid conditions, such as COPD (4.2%), peptic ulcer disease (2.8%), and solid tumors Table 6 Un-adjusted and adjusted impact of individual co-morbidities that contribute to Charlson co-morbidity index on cardiac death and major adverse cardiovascular events at 30-days, 1 and 5 years (2.6%), were the most common noncardiovascular comorbid conditions.…”