Coronary heart disease in diabetics: Prognostic implications and results of interventions

Figures & data

Table I.  Baseline characteristics.

Variable	Non-diabetics n = 12 036	Diabetics n = 1 475	p-value
Age (mean±S.D.)	62.3	64.1	p < 0.001
Female%	35.1	36.8	p = 0.19
EF% (mean±S.D.)	69.3	67.4	p < 0.001
LVEDP mmHG (mean±S.D.)	13.1	14.5	p < 0.001
Generalized arteriosclerosis%*	3.4	4.2	p = 0.12
Other significant disease%†	2.6	6.2	p < 0.001
CCS function class%
0	3.5	3.0
I	10.2	7.6
II	39.3	31.8
III	33.6	40.4
IV	13.4	17.2	p < 0.001
Unstable angina%	18.0	22.0	p < 0.001
Ischemia on EECG%	34.7	32.6	p = 0.12
Hypertension%	30.4	52.3	p < 0.001
Current smoker%	25.3	20.0	p < 0.001
Previous myocardial infarction%	33.5	40.2	p < 0.001
Radial entry site%	84.3	86.0	p = 0.09
Angiographic results
No coronary disease%	20.5	8.9
Not significant coronary disease%	12.0	11.7
One vessel disease%	21.8	18.8
Two vessel disease%	17.6	19.3
Three vessel disease%	28.2	41.4	p < 0.001

EF = left ventricular ejection fraction. LVEDP = left ventriclular end diastolic pressure. CCS function class = Canadian Cardiovascular Society function class for angina. EECG = exercise ECG.

*Generalized arteriosclerosis was defined by previous extracardiac arteriosclerotic symptoms. †Other clinical significant renal, hepatic, pulmonary disease or significant obesity defined at the discretion of the treating physician.

Figure 1.  Unadjusted survival estimates in non-diabetics and diabetics. The difference is statistical significant (p < 0.001, log-rank test).

Figure 2.  Survival curves from the Cox model showing the interaction between diabetes and smoking. The interaction term is highly significant (p = 0.007).

Figure 3.  Survival curves from Cox model with age, ejection fraction and diabetes as significant covariates in the subgroup where intervention was deemed not possible. The difference in survival between diabetics and non-diabetics is highly significant (p = 0.002) with a hazard ratio of 2.34 (95% CI 1.36–4.04).

Table II.  Initial revascularization treatment strategy.

Strategy	Non-diabetics n = 12 036	Diabetics n = 1 475	p-value
Intervention not necessary%	33.6	21.6
Intervention not possible%	2.6	4.1
PCI%	35.8	34.6
CABG%	28.0	39.7	p < 0.001

Figure 4.  Survival curves from Cox model in the PCI treated cohort showing the interaction between diabetes and smoking with a significantly higher mortality rate in the diabetics that smoked (p = 0.012 for the interaction term).

Figure 5.  Survival curves from Cox model in patients treated with CABG. In this subgroup neither the interaction term between diabetes and smoking is significant (p = 0.225) nor the increased hazard ratio for diabetics (p = 0.34).

Figure 6.  Cumulative hazard of the first new revascularization (PCI or CABG). The difference in new revascularization between initial PCI or CABG is highly significant (p < 0.001, log-rank test), while the difference between diabetics and non-diabetics is not (p = 0.09, log-rank test).

Figure 7.  Cumulative hazard of repeat CABG divided in groups of diabetics and non-diabetics and type of initial revascularization therapy. Diabetics had significantly increase hazard in the PCI group (p < 0.0001), while there was no difference in the CABG group (p = 0.362).