Key result
Long-term follow-up post-PCI in patients with insulin-treated type 2 diabetes mellitus was associated with significantly higher odds of major adverse cardiac events compared to short-term follow-up (OR 3.33).
Why the study?
Very few studies had compared short-term to long-term adverse cardiovascular outcomes following PCI in patients with insulin-treated type 2 diabetes mellitus.
Are adverse cardiovascular outcomes more likely during long-term compared to short-term follow-up post-PCI in patients with insulin-treated type 2 diabetes mellitus?
Meta-Analysis (n=1,568)
Are adverse cardiovascular outcomes more likely during long-term compared to short-term follow-up post-PCI in patients with insulin-treated type 2 diabetes mellitus?
Odds Ratio: 3.33 (95% CI 2.64–4.21)
p-value: p=0.00001
In patients with insulin-treated type 2 diabetes undergoing PCI with drug-eluting stents, adverse cardiovascular outcomes including MACE, mortality, MI, and repeat revascularization are significantly higher in the long-term compared to short-term follow-up.
Heightened long-term MACE risk post-PCI in insulin-treated T2DM supports prolonged monitoring; extends temporal risk data but requires prospective validation.
INTRODUCTION: Type 2 diabetes mellitus (T2DM) is a major health issue, especially in patients with coexisting coronary artery disease (CAD). Patients with insulin-treated T2DM (ITDM) have worse outcomes than those with non-insulin-treated T2DM. Very few studies have compared short-term to long-term adverse cardiovascular outcomes following percutaneous coronary intervention (PCI) in patients on insulin therapy. Therefore, in this meta-analysis, we systematically compared short-term to long-term adverse cardiovascular outcomes in a population of patients with ITDM following PCI. METHODS: We searched for English-language publications focusing on PCI in patients with ITDM using specific search terms/phrases. All the participants accepted for inclusion in this meta-analysis were treated with a drug-eluting stent. Post-intervention adverse cardiovascular outcomes observed during short-term and long-term follow-up periods were assessed and compared. Statistical analysis was carried out using the popular RevMan 5.3 software. Odd ratios (OR) with 95% confidence intervals (CI) were calculated. RESULTS: Six studies comprising 1568 participants with ITDM in total were included in this simple meta-analysis. Patient enrollment periods varied but enrollment occurred during the years 1993-2012. When a fixed-effects statistical model was used, post-PCI adverse cardiovascular outcomes-such as major adverse cardiac events (MACEs) (OR 3.33, 95% CI 2.64-4.21; P = 0.00001), all-cause mortality (OR 5.73, 95% CI 3.37-9.73; P = 0.00001), myocardial infarction (MI) (OR 1.47, 95% CI 1.05-2.07; P = 0.02), and repeated revascularization (OR 4.78, 95% CI 3.29-6.94; P = 0.00001)-were found to be significantly more likely during the long-term follow-up period. A similar result was observed with a random-effects statistical model. CONCLUSION: Adverse cardiovascular outcomes post PCI were significantly more likely during the long-term follow-up period than during the short-term follow-up period in these patients with T2DM on insulin therapy. This hypothesis requires confirmation via new comparative trials that consider short-term and long-term follow-up periods.
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Lu et al. (2019) conducted a meta-analysis in Insulin-treated type 2 diabetes mellitus (ITDM) post percutaneous coronary intervention (PCI) (n=1,568). Long-term follow-up post-PCI vs. Short-term follow-up post-PCI was evaluated on Major adverse cardiac events (MACEs) (OR 3.33, 95% CI 2.64-4.21, p=0.00001). Long-term follow-up post-PCI in patients with insulin-treated type 2 diabetes mellitus was associated with significantly higher odds of major adverse cardiac events compared to short-term follow-up (OR 3.33).
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