# Impact of diabetes on three-year outcome after coronary stenting in patients with polyvascular atherosclerotic disease – a secondary analysis of the randomized TWENTE trials

## TL;DR

Diabetes significantly increases the risk of adverse outcomes after heart stenting in patients with widespread artery disease, mainly due to higher death rates.

## Contribution

This study quantifies the additional risk diabetes poses in polyvascular disease patients undergoing coronary stenting, showing a more than 50% increase in event risk.

## Key findings

- Diabetes increases the risk of major adverse cardiac events by 49% in polyvascular disease patients after stenting.
- All-cause mortality is more than twice as high in diabetic patients compared to non-diabetic ones.
- Insulin-treated diabetic patients show the highest risk of adverse outcomes.

## Abstract

•Diabetes rises event risk after coronary stenting in polyvascular disease patients.•We examine to which extent diabetes increases the already elevated event risk.•Diabetes rises the event risk in polyvascular disease patients by > 50 %.•This is mainly attributable to more deaths from any cause.•These data suggest that strong preventive measures are warranted in these patients.

Diabetes rises event risk after coronary stenting in polyvascular disease patients.

We examine to which extent diabetes increases the already elevated event risk.

Diabetes rises the event risk in polyvascular disease patients by > 50 %.

This is mainly attributable to more deaths from any cause.

These data suggest that strong preventive measures are warranted in these patients.

The presence of polyvascular atherosclerotic disease is associated with a high-risk of adverse events following percutaneous coronary intervention (PCI). As the extent to which the presence of diabetes further increases this elevated risk is unclear, based on current literature, we sought to assess the long-term outcome after PCI in patients with polyvascular disease, comparing those with and without diabetes.

The current study population consists of patients with known polyvascular disease, identified from a pooled patient-level database of 4 PCI trials in all-comers treated with new-generation drug-eluting stents; no exclusion criteria were set. The main composite endpoint was major adverse cardiac event (MACE: any myocardial infarction, emergent coronary bypass surgery, clinically indicated target lesion revascularization, or all-cause mortality).

695 patients had polyvascular disease of whom 208(29.9 %) had diabetes. Patients with diabetes were older, had a higher body-mass-index, and had a higher prevalence of hypertension than those without diabetes. At 3-year follow-up, the incidence of MACE was significantly higher in polyvascular disease patients with diabetes (24.6 % vs.16.4 %, adj.HR:1.49, 95 %CI:1.05–2.12, p = 0.03), in particular insulin-treated patients, and was primarily attributable to a disparity in all-cause mortality which was more than twice as high in patients with diabetes (15.4 % vs.7.2 %, p < 0.001). Furthermore, the risk of repeated target vessel revascularization was higher in patients with diabetes (12.0 % vs7.0 %, adj.HR:1.88, 95 %CI:1.12–3.16, p = 0.02).

In the high-risk population of PCI patients with polyvascular disease, the presence of diabetes represents a profoundly significant additional risk factor at long-term follow-up, associated with significantly higher adverse event risks.

Trial registration:ClinicalTrials.gov NCT01066650 NCT0133170 NCT01674803 NCT02508714.