Residual Angina After Elective Percutaneous Coronary Intervention in Patients With Diabetes Mellitus

• Authors: Anna Grodzinsky, Saint Luke’s Mid America Heart Institute; Mikhail Kosiborod, Saint Luke’s Mid America Heart Institute; Fengming Tang, Saint Luke’s Mid America Heart Institute; Philip G. Jones, Saint Luke’s Mid America Heart Institute; Darren K. McGuire, University of Texas; John A. Spertus, Saint Luke’s Mid America Heart Institute; John F. Beltrame, University of Adelaide; Jae-Sik Jang, Saint Luke’s Mid America Heart Institute; Abhinav Goyal, Emory University; Neel M. Butala, Massachusetts General Hospital; Robert W. Yeh, Beth Israel Deaconess Medical Center; Suzanne V. Arnold, Saint Luke’s Mid America Heart Institute
• Journal Title: Circulation: Cardiovascular Quality and Outcomes
• Volume: Volume 10, Number 9
• Publisher: American Heart Association | 2017-09-01, Pages e003553-e003553
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1161/CIRCOUTCOMES.117.003553
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; coronary artery disease; diabetes mellitus; myocardial ischemia; percutaneous coronary intervention; risk; SILENT-MYOCARDIAL-ISCHEMIA; QUALITY-OF-LIFE; CHRONIC STABLE ANGINA; PROSPECTIVE COHORT; DISEASE; TRIAL; QUESTIONNAIRE; RANOLAZINE; INFARCTION; OUTCOMES

Abstract

Background-Previous studies suggest that among patients with stable coronary artery disease, patients with diabetes mellitus (DM) have less angina and more silent ischemia when compared with those without DM. However, the burden of angina in diabetic versus nondiabetic patients after elective percutaneous coronary intervention (PCI) has not been recently examined. Methods and Results-In a 10-site US PCI registry, we assessed angina before and at 1, 6, and 12 months after elective PCI with the Seattle Angina Questionnaire angina frequency score (range, 0-100, higher=better). We also examined the rates of antianginal medication prescriptions at discharge. A multivariable, repeated-measures Poisson model was used to examine the independent association of DM with angina over the year after treatment. Among 1080 elective PCI patients (mean age, 65 years; 74.7% men), 34.0% had DM. At baseline and at each follow-up, patients with DM had similar angina prevalence and severity as those without DM. Patients with DM were more commonly prescribed calcium channel blockers and long-Acting nitrates at discharge (DM versus not: 27.9% versus 20.9% [P=0.01] and 32.8% versus 25.5% [P=0.01], respectively), whereas β-blockers and ranolazine were prescribed at similar rates. In the multivariable, repeated-measures model, the risk of angina was similar over the year after PCI in patients with versus without DM (relative risk, 1.04; range, 0.80-1.36). Conclusions-Patients with stable coronary artery disease and DM exhibit a burden of angina that is at least as high as those without DM despite more antianginal prescriptions at discharge. These findings contradict the conventional teachings that patients with DM experience less angina because of silent ischemia.