Abstract 211: Long-Term Mortality in Diabetic Patients with Non-Obstructive Coronary Disease Undergoing Coronary Angiography/Cardiac Catheterization

Background: Diabetes mellitus is associated with poorer outcomes in patients with cardiovascular disease and patients with diabetes are at increased risk of death. Several studies with coronary computed tomography have shown that, for equal numbers of severely diseased coronary arteries, the outcomes of patients with diabetes is worse compared to patients without diabetes. However, it is unclear if the outcomes of diabetic patients with non-obstructive coronary disease is different than the outcomes of patients without diabetes and non-obstructive disease. Methods and Results: We studied 901 consecutive, predominantly (98%) male patients undergoing coronary angiography/cardiac catheterization at a veterans’ administration medical center who had normal coronaries or non-obstructive coronary artery disease and we assessed the association between diabetic status and mortality. The mean age of the patients was 64.4 years. One third of the patients (n=311, 34.5%) were diabetic. Diabetic patients were the same age, and had the same baseline creatinine, but were more often hypertensive, and were more often on statins, angiotensin receptor blockers, angiotensin conversion enzyme inhibitors, calcium channel blockers and aspirin therapy compared to the non-diabetic patients. Contrast-induced nephropathy (CIN) occurred in 8 (2.57%) diabetic patients and in 11 (1.86%) non-diabetic patients at 72 hours after the procedure (odds ratio [OR] 1.39; 95% confidence interval [CI] 0.55 - 3.49; P= 0.48). At 3 months, renal dysfunction was seen in 34 (10.93%) diabetic patients versus 32 (5.42%) of the non-diabetic group (OR 2.14, CI 1.29 - 3.54; P=0.0032). After a median follow up of 67 months 59 patients (18.97 %) of the diabetic group had died versus 72 (12.20 %) of the non-diabetic group (OR 1.68, CI 1.16 - 2.45; P=0.0007). On multivariate analysis, after adjustment for age, comorbidities, medical therapy, baseline creatinine and the incidence of CIN, the presence of diabetes was significantly associated with the 5 year mortality (OR= 2.10, 95% CI 1.44 - 3.85, P=0.0006). Conclusion: In this cohort of patients undergoing coronary angiography who had normal coronaries or non-obstructive coronary disease, diabetes was associated with an increased mortality.