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Impact of Diabetes Mellitus on Long-Term Mortality in Patients Presenting for Coronary Angiography.

Impact of Diabetes Mellitus on Long-Term Mortality in Patients Presenting for Coronary Angiography.
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Zafrir B, Jaffe R, Rubinshtein R, Karkabi B, Flugelman MY, Halon DA,


Zafrir B, Jaffe R, Rubinshtein R, Karkabi B, Flugelman MY, Halon DA, (click to view)

Zafrir B, Jaffe R, Rubinshtein R, Karkabi B, Flugelman MY, Halon DA,

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The American journal of cardiology 2017 01 25119(8) 1141-1145 pii S0002-9149(17)30049-8
Abstract

To understand the current impact of diabetes mellitus (DM) on long-term outcomes among patients referred for coronary angiography, we studied 14,337 consecutive patients (5,279 diabetic patients [37%]) referred to coronary angiography for assessment or treatment of coronary artery disease. We investigated long-term all-cause mortality and its interaction with hypoglycemic therapy and presenting coronary status. At baseline, patients with DM had more hypertension, hyperlipidemia, and renal failure; more were women, overweight, and more had previous coronary interventions. Mortality was higher in those with DM and was related to treatment status: multivariate adjusted hazard ratio during a median follow-up period of 78 months was 1.41 (95% CI 1.11 to 1.80, p = 0.006) for diet only-treated DM, 1.63 (95% CI 1.51 to 1.77, p <0.001) for DM treated with oral hypoglycemics, and 2.50 (95% CI 2.20 to 2.85, p <0.001) for DM requiring insulin therapy. The earlier findings were similar in magnitude in patients presenting with acute or stable coronary syndromes. In addition, long-term mortality of medically treated DM presenting with a stable coronary syndrome was even higher than that of nondiabetic patients presenting with an acute coronary syndrome (hazard ratio 1.21, 95% CI 1.08 to 1.35, p = 0.001). In conclusion, in patients referred for coronary angiography in the current era, DM remained an independent predictor of long-term mortality regardless of the coronary presentation and mortality increased in direct relation to intensity of hypoglycemic therapy at presentation.

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