Author + information
- Ridhima Goel,
- Paul Guedeney,
- Bimmer Claessen,
- Mortiz Blum,
- Roxana Mehran and
- Marco Valgimigli
The impact of diabetes mellitus (DM) in a high bleeding risk (HBR) population undergoing percutaneous coronary intervention (PCI) remains unclear. We sought to investigate 4-year outcomes after PCI with a Xience V stent in this subgroup.
We used the pooled database of 4 all comer, real world post approval trials (XIENCE V USA, XIENCE V Japan, XIENCE V China and XIENCE V India). Outcomes of interest adjudicated at 4 years were: major cardiac adverse events [MACE - cardiac death/myocardial infarction (MI)/stent thrombosis (ST)], all cause death, ischemia driven target lesion revascularization (ID TLR), and major bleeding. Kaplan Meier estimates were used for time to event analyses.
A total of 3,489 patients were categorized as HBR on the basis of prespecified bleeding determinants, of which 41.9% (1,463) were DM patients. Compared to non-DM, DM patients were more likely to be female (p = 0.04), have multivessel disease (p=0.0005), prior cardiac intervention (p <0.0001), renal insufficiency (p<0.0001), anemia (p<0.0001), and ≥2 HBR criteria (p<0.0001). At 4 year follow-up, DM patients were at higher risk of mortality, MACE, MI, ID-TLR and major bleeding [Table 1]. At 4 years, DM in the HBR population was an independent predictor for MACE (HR 1.47, 95% CI, p=0.002) and major bleeding (HR 1.57, 95%CI, p=0.01). Multivariable analyses using Cox regression will be presented.
DM is frequent among the HBR patients and is associated with worse outcomes 4 years after index PCI.
|Adverse Outcomes||Diabetic Patients (n =1463)||Non-Diabetic Patients (n=2026)||Diabetic vs. Non-Diabetic Unadjusted HR [95% CI]||P value|
|All-Cause Death (%)||18.7||13.5||1.43||<0.0001|
|Major Adverse cardiac Events (cardiac death/MI/ST) (%)||13.0||8.9||1.48||0.0003|
|Myocardial Infarction (%)||4.9||3.3||1.45||0.04|
|Cardiac Death (%)||9.7||6.3||1.54||0.0007|
|Definite or Probable Stent Thrombosis (ARC) (%)||1.6||1.4||1.09||0.77|
|Non-Cardiac death (%)||10.0||7.7||1.33||0.02|
|Ischemia-Driven Target Lesion Revascularization (%)||9.7||5.7||1.75||<0.0001|
|Major Bleeding (%)||5.5||3.6||1.51||0.013|
Poster Hall, Hall F
Sunday, March 17, 2019, 9:45 a.m.-10:30 a.m.
Session Title: Interventional Cardiology: Complex Patients/Comorbidities 3
Abstract Category: 19. Interventional Cardiology: Complex Patients/Comorbidities
Presentation Number: 1204-057
- 2019 American College of Cardiology Foundation