Impact diabetes mellitus in patients undergoing percutaneous coronary intervention

espanolLa diabetes mellitus (DM) se ha asociado a un incremento en los resultados adversos en pacientes tratados con angioplastia coronaria, en comparacion a los pacientes no diabeticos. Objetivos: Evaluar la prevalencia de eventos cardiovasculares mayores en pacientes diabeticos, de acuerdo a la severidad del trastorno metabolico, en una poblacion de pacientes no seleccionada tratados con angioplastia coronaria. Metodos: Analisis de registro, unicentrico y retrospectivo de pacientes con enfermedad coronaria tratados con ATC desde Marzo 2009 a Junio 2018, segun el estado y severidad de la DM. Se aplico un modelo de regresion de Cox ajustado para evaluar la relacion entre el estado diabetico y el riesgo de eventos cardiovasculares mayores. Resultados: Se incluyeron 6313 pacientes (seguimiento promedio 4.1 ± 1.8 anos), con una prevalencia global de DM del 22.8% (DM no insulinorrequirientes 19.1%; DM insulinorrequirientes 3.8%). Los pacientes diabeticos presentaron un perfil de riesgo elevado, particularmente los DM-IR. Al seguimiento promedio, el riesgo ajustado de eventos cardiovasculares mayores fue similar entre los pacientes No-DM y los DM-NIR (HR 1.02 [0.81 – 1.27], p 0.85). En relacion a los pacientes DM-IR, se observo un riesgo elevado en comparacion a los No-DM (HR 1.73 [1.20 – 2.49], p 0.003) y a los DM-NIR (HR 1.65 [1.10 – 2.48], p 0.015). Se observo una interaccion significativa entre el estado diabetico y el riesgo de eventos segun la indicacion de la angioplastia coronaria al ingreso (pint 0.045). Conclusion: En nuestra serie de pacientes no seleccionados tratados con angioplastia coronaria y con seguimiento a largo plazo, los pacientes con DM-IR presentaron un riesgo diferencial de eventos cardiovasculares mayores en comparacion a los pacientes No-DM y a los DM-NIR. Si bien existe controversia al respecto, en estos ultimos no observamos un riesgo elevado de MACE en comparacion a los No-DM. EnglishDiabetes mellitus (DM) has been associated with an increase in adverse outcomes in patients treated with coronaryangioplasty, compared to non-diabetic patients.Objective: To evaluate the risk of major adverse cardiovascular events in diabetic patients, stratified according to the treatment(non-insulin dependent or insulin-dependent), in a population of unselected patients treated with coronary angioplasty.Methods: Registry-based analysis of patients with coronary artery disease undergoing percutaneous coronary interventionfrom March 2009 to June 2018, according presence of DM stratified according to the established treatment for the metabolicdisorder: insulin-dependent DM (ID-DM) and non-insulin dependent DM (NID-DM). An adjusted Cox regression model wasapplied to evaluate the relationship between the diabetic status and the risk of major adverse cardiovascular events.Results: A total of 6313 patients were included (mean follow-up 4.1 ± 1.8 years), with a global prevalence of DM of 22,8% (noninsulindependent DM 19,1%, insulin-dependent DM 3,8%). Diabetic patients showed a higher risk profile, particularly thosewith ID-DM. At the average follow-up, the adjusted risk of MACE was similar between Non-DM patients and the NIR-DMpatients (HR 1,02 [0,81-1,27], p 0.85). In relation to DM-IR patients, it was observed a higher risk of MACE in comparisonto Non-DM (HR 1,73 [1,20-2,49], p 0.003) and NIR-DM (HR 1,65 [1,10-2,48], p 0.015). A significant interaction was observedbetween the diabetic status and the risk of MACE according to the indication of the percutaneous coronary artery intervention(pint 0.045).Conclusions: In our registry of patients undergoing PCI, with long-term follow-up, DM patients had a higher risk of MACE.The risk of MACE was particularly increased in ID-DM patients. However, there were no significant differences in the riskof MACE between DM-NIR and non-DM patients.