Impact of diabetes on three-year outcome after coronary stenting in patients with polyvascular atherosclerotic disease – a secondary analysis of the randomized TWENTE trials
Background: 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 sough...
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Elsevier
2025-08-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906725001447 |
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| author | Daphne van Vliet Tineke H. Pinxterhuis Eline H. Ploumen Marlies M. Kok Rosaly A. Buiten Paolo Zocca Ariel Roguin Carl E. Schotborgh Rutger L. Anthonio Peter W. Danse Edouard Benit Adel Aminian Carine J.M. Doggen Clemens von Birgelen |
| author_facet | Daphne van Vliet Tineke H. Pinxterhuis Eline H. Ploumen Marlies M. Kok Rosaly A. Buiten Paolo Zocca Ariel Roguin Carl E. Schotborgh Rutger L. Anthonio Peter W. Danse Edouard Benit Adel Aminian Carine J.M. Doggen Clemens von Birgelen |
| author_sort | Daphne van Vliet |
| collection | DOAJ |
| description | Background: 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. Methods: 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). Results: 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). Conclusions: 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. |
| format | Article |
| id | doaj-art-ac8d39ff7f624c3f8bd7cb2a57a9850a |
| institution | Matheson Library |
| issn | 2352-9067 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj-art-ac8d39ff7f624c3f8bd7cb2a57a9850a2025-07-07T04:06:38ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672025-08-0159101741Impact of diabetes on three-year outcome after coronary stenting in patients with polyvascular atherosclerotic disease – a secondary analysis of the randomized TWENTE trialsDaphne van Vliet0Tineke H. Pinxterhuis1Eline H. Ploumen2Marlies M. Kok3Rosaly A. Buiten4Paolo Zocca5Ariel Roguin6Carl E. Schotborgh7Rutger L. Anthonio8Peter W. Danse9Edouard Benit10Adel Aminian11Carine J.M. Doggen12Clemens von Birgelen13Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, the NetherlandsDepartment of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, the NetherlandsDepartment of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, the NetherlandsDepartment of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the NetherlandsDepartment of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the NetherlandsDepartment of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the NetherlandsDepartment of Cardiology, Hillel Yaffe Medical Center, Hadera and B. Rappaport-Faculty of Medicine, Israel, Institute of Technology, Haifa, IsraelDepartment of Cardiology, Haga Hospital, The Hague, the NetherlandsDepartment of Cardiology, Treant Zorggroep, Scheper Hospital, Emmen, the NetherlandsDepartment of Cardiology, Rijnstate Hospital, Arnhem, the NetherlandsDepartment of Cardiology, Jessa Hospital, Hasselt, BelgiumDepartment of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium; Department of Cardiology, Ziekenhuisgroep Twente, Almelo and Hengelo, the NetherlandsDepartment of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, the NetherlandsDepartment of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, the Netherlands; Corresponding author at: Department of Cardiology (A-25), Thoraxcentrum Twente, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ Enschede, the Netherlands.Background: 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. Methods: 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). Results: 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). Conclusions: 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.http://www.sciencedirect.com/science/article/pii/S2352906725001447Coronary artery diseasePeripheral arterial diseasePolyvascular diseaseDiabetes mellitusPercutaneous coronary intervention |
| spellingShingle | Daphne van Vliet Tineke H. Pinxterhuis Eline H. Ploumen Marlies M. Kok Rosaly A. Buiten Paolo Zocca Ariel Roguin Carl E. Schotborgh Rutger L. Anthonio Peter W. Danse Edouard Benit Adel Aminian Carine J.M. Doggen Clemens von Birgelen Impact of diabetes on three-year outcome after coronary stenting in patients with polyvascular atherosclerotic disease – a secondary analysis of the randomized TWENTE trials International Journal of Cardiology: Heart & Vasculature Coronary artery disease Peripheral arterial disease Polyvascular disease Diabetes mellitus Percutaneous coronary intervention |
| title | Impact of diabetes on three-year outcome after coronary stenting in patients with polyvascular atherosclerotic disease – a secondary analysis of the randomized TWENTE trials |
| title_full | Impact of diabetes on three-year outcome after coronary stenting in patients with polyvascular atherosclerotic disease – a secondary analysis of the randomized TWENTE trials |
| title_fullStr | Impact of diabetes on three-year outcome after coronary stenting in patients with polyvascular atherosclerotic disease – a secondary analysis of the randomized TWENTE trials |
| title_full_unstemmed | Impact of diabetes on three-year outcome after coronary stenting in patients with polyvascular atherosclerotic disease – a secondary analysis of the randomized TWENTE trials |
| title_short | Impact of diabetes on three-year outcome after coronary stenting in patients with polyvascular atherosclerotic disease – a secondary analysis of the randomized TWENTE trials |
| title_sort | impact of diabetes on three year outcome after coronary stenting in patients with polyvascular atherosclerotic disease a secondary analysis of the randomized twente trials |
| topic | Coronary artery disease Peripheral arterial disease Polyvascular disease Diabetes mellitus Percutaneous coronary intervention |
| url | http://www.sciencedirect.com/science/article/pii/S2352906725001447 |
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