PCI outcomes worsened by concurrent diabetes, hypertension
MedWire News: Diabetic patients who undergo percutaneous coronary intervention (PCI) have a higher risk for adverse outcomes than nondiabetics who have the same procedure, study findings suggest.
This risk is further amplified if the diabetic patient also has hypertension; however, hypertension per se does not appear to worsen outcomes after PCI.
"Patients with hypertension run an increased risk for myocardial infarction (MI), stroke, and congestive heart failure after PCI, and this is probably related in part to more widespread coronary artery disease," remark the authors in the American Journal of Medicine.
The findings arise from an analysis of the outcomes of 44,268 Swedish patients who underwent PCI between 2006 and 2008 and were followed-up for a mean period of 2 years post-PCI.
During this period 6.4% of the cohort died. Patients with both diabetes and hypertension (n=6795) had the highest 30-day death rate, at 3.8%, followed by those with diabetes alone (n=2785), at 3.4%.
Patients with hypertension but no diabetes had the lowest 30-day death rate, at 2.0%.
Johan Herlitz (University of Gothenburg, Göteborg, Sweden) and colleagues found that patients with diabetes and hypertension had a 30-day mortality risk that was twice that of those without diabetes or hypertension (n=18,409).
Furthermore, patients with hypertension alone had a 73% higher 30-day mortality risk than those without diabetes or hypertension, but no significant risk increase was observed among those with hypertension alone.
These hypertension-only patients however, had a 10% higher 2-year risk for MI than those without hypertension or diabetes (95% confidence interval [CI]: 1.01-1.19), and this risk rose fourfold in hypertensive patients with diabetes (95% CI: 1.26-1.52).
Herlitz and team also observed a similar trend for an increased post-PCI stroke and congestive heart failure risk among diabetic patients with hypertension compared with those with hypertension-only or neither condition.
Of note, compared with patients without diabetes or hypertension, those with diabetes alone had an increased risk for MI, stroke, and CHF that was higher than that associated with hypertension alone, but lower than that seen with concurrent diabetes and hypertension.
"This study showed that diabetic patients still run a high risk of a negative outcome after PCI, especially when combined with hypertension. Our data imply that even greater efforts are needed to improve prognosis," concludes the team.
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By Lauretta Ihonor