The Impact of Hypertension and Diabetes on Outcome in Patients Undergoing Percutaneous Coronary Intervention

ArticleinThe American journal of medicine 124(3):265-75 · March 2011with14 Reads
DOI: 10.1016/j.amjmed.2010.09.015 · Source: PubMed
Information relating the outcome of percutaneous coronary intervention to diabetes mellitus or hypertension is limited. The study objective was to describe the outcome in patients undergoing percutaneous coronary intervention in relation to diabetes and hypertension. Data were extracted from 5 national registers: the Swedish Coronary Angiography and Angioplasty Register (all percutaneous coronary interventions), the Prescribed Drug Registry (all prescribed pharmaceuticals purchased in Swedish pharmacies), the Swedish Hospital Discharge Register (data on myocardial infarction, revascularization, stroke, and congestive heart failure from in-hospital and specialist health care), and the National Population Register and Cause of Death Register (data on death). We included all "first percutaneous coronary interventions" between January 1, 2006, and December 31, 2008 (n=44,268; followed an average of 1.9 [± 0.9] years). Mortality was 6.4% and highest in patients with diabetes plus hypertension. Hypertension per se did not increase mortality or the risk for repeat intervention, but carried a 10% increased risk for subsequent myocardial infarction, increasing to a 4-fold increase when combined with diabetes. Stroke occurred in 2%; the importance of hypertension was evident in nondiabetic patients, but even stronger in diabetic patients. Congestive heart failure caused hospital admission in 8%, with a negative influence from hypertension with and without diabetes. After percutaneous coronary intervention and with modern pharmacotherapy, diabetes had a negative effect on the outcome, especially when combined with hypertension. Hypertension per se was not associated with increased mortality but with an increased risk for myocardial infarction, stroke, and congestive heart failure, probably related to widespread coronary artery disease. Improved diabetes care might improve the prognosis.
    • "MI, myocardial infarction; MACE, major adverse cardiac event. angina and estimated other endpoints such as stroke and hospitalization for heart failure compared with our study [36]. Another previous study showed a lower mortality rate than the present study, but this result may be caused by inclusion of acute MI as well as lower risk population such as unstable angina [11]. "
    [Show abstract] [Hide abstract] ABSTRACT: The synergistic effect of diabetes mellitus (DM) and hypertension on mid-term outcome among acute myocardial infarction (MI) patients undergoing percutaneous coronary intervention (PCI) is still controversial. A total of 2438 patients with acute MI who underwent PCI from January 2007 to November 2010 were studied. Patients were stratified to four groups according to the presence of DM or hypertension and followed up during 12 months. We analyzed the influence of hypertension and DM on major adverse cardiac events (MACE: death, recurrent MI, repeated coronary artery revascularization). No history of hypertension or DM was found in 35.0%, a history of hypertension in 27.2%, a history of DM in 15.0%, and a history of both disease entities in 22.8%. The rate of MACE was significantly higher in hypertensive DM group (15.9% vs. 22.9% vs. 28.8% vs. 37.0%, log-rank p<0.001). In multivariate analysis, hypertension and DM were meaningful predictors of mid-term mortality, and the combination of the two was a stronger predictor (hazard ratio=1.790; 95% confidence interval=1.313-2.442; p<0.001). After PCI, acute MI patients with a history of DM or hypertension had a higher mid-term mortality than acute MI patients without such a history. The combination of DM and hypertension appeared to be more strongly associated with mortality than DM or hypertension alone.
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