Patency of percutaneous transluminal coronary angioplasty sites at 6-month angiographic follow-up : A key determinant of survival in diabetics after coronary balloon angioplasty

• Published in: Circulation (New York, N.Y.) Vol. 103; no. 9; pp. 1218 - 1224
• Main Authors: VAN BELLE, Eric, KETELERS, Régis, BAUTERS, Christophe, PERIE, Marc, ABOLMAALI, Kaveh, RICHARD, Florence, LABLANCHE, Jean-Marc, MCFADDEN, Eugène P, BERTRAND, Michel E
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 06.03.2001; American Heart Association, Inc
• Subjects: Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Coronary Angiography; Coronary Disease - mortality; Coronary Disease - physiopathology; Coronary Disease - therapy; Diabetic Angiopathies - mortality; Diabetic Angiopathies - therapy; Diseases of the cardiovascular system; Female; Follow-Up Studies; Heart Ventricles - pathology; Heart Ventricles - physiopathology; Humans; Male; Medical sciences; Middle Aged; Multivariate Analysis; Proportional Hazards Models; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Survival Analysis; Survival Rate; Endocrinopathy; Human; Prognosis; Radiodiagnosis; Angiography; Diabetes mellitus; Coronary artery; Instrumentation therapy; Cuffed tube; Instrumental dilatation; Survival; Restenosis; Treatment; Follow up study
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.103.9.1218

Several reports have demonstrated a high mortality rate in diabetic patients treated by standard coronary balloon angioplasty. No clear explanation has been provided for this finding. Consecutive diabetic patients successfully treated by standard coronary balloon angioplasty (n=604) were enrolled in a follow-up program including repeated angiography at 6 months and long-term clinical follow-up. Clinical follow-up was available in 603 patients (99.8%). Twelve patients died, 2 underwent bypass surgery before scheduled repeated angiography, and 76 declined angiography. Determinants of long-term mortality were analyzed in the 513 patients with angiography at 6 months and long-term clinical follow-up (mean follow-up, 6.5+/-2.4 years). On the basis of the results of repeated angiography, 3 groups of patients were defined: group 1, 162 patients without restenosis (32%); group 2, 257 patients with nonocclusive restenosis (50%); and group 3, 94 patients with coronary occlusion (18%). Overall actuarial 10-year mortality rate was 36%. Actuarial 10-year mortality was 24% in group 1, 35% in group 2, and 59% in group 3 (P:<0.0001). Multivariate analysis demonstrated that coronary occlusion was a strong and independent correlate of long-term total mortality (hazard ratio, 2.16; 95% CI, 1.43 to 3.26; P:=0.0003) and cardiac mortality (hazard ratio, 2.38; 95% CI, 1.48 to 3.85; P:=0.0004). This study demonstrates that restenosis, especially in its occlusive form, is a major determinant of long-term mortality in diabetic patients after coronary balloon angioplasty.