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Hypertension or diabetes; which is worse prognostic factor for acute coronary syndrome patients following percutaneous coronary intervention?

Session Poster session 7

Speaker Yong Hoon Kim

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease and Comorbidities
  • Session type : Poster Session

Authors : YH Kim (Chuncheon City,KR), AY Her (Chuncheon City,KR), SW Rha (Seoul,KP), BG Choi (Seoul,KP), SY Choi (Seoul,KP), JK Byun (Seoul,KP), CU Choi (Seoul,KP), EJ Kim (Seoul,KP), CG Park (Seoul,KP), HS Seo (Seoul,KP), DJ Oh (Seoul,KP)

Authors:
Y.H. Kim1 , A.Y. Her1 , S.W. Rha2 , B.G. Choi2 , S.Y. Choi2 , J.K. Byun2 , C.U. Choi2 , E.J. Kim2 , C.G. Park2 , H.S. Seo2 , D.J. Oh2 , 1Kangwon National University Hospital - Chuncheon City - Korea Republic of , 2Korea University Guro Hospital - Seoul - Korea Republic of ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 1400

Background: Hypertension and diabetes are well known risk factors of ischemic coronary artery disease (CAD). However, head-to-head comparison results regarding their impact on long-term (10-year) clinical outcomes in acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) are rare.

Methods: From April 2003 to May 2015, a total of 2056 ACS patients who had hypertension or diabetes were enrolled. The patients who had both hypertension and diabetes were excluded. Finally, a total of 1344 eligible ACS patients who had hypertension (n=1,108) or diabetes (n=236) were enrolled. To adjust for any potential confounders, a propensity score matched (PSM) analysis was performed using the logistic regression model and 2 propensity-matched groups (236 pairs, n=472, C-statistic = 0.785) were generated. Cumulative major adverse cardiac events (MACEs) up to 10-year were compared between the hypertension group and diabetes group. MACEs was defined as total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and non-target vessel revascularization (Non-TVR).

Results: Up to 10-year follow-up periods, the cumulative incidence of total death, non-fatal MI, TLR, TVR and non-TVR were not significantly different between the hypertension group and diabetes group. Further, the cumulative incidence of MACEs were also similar between the two groups (Table).

Conclusions: Up to 10-year follow-up periods, hypertension and diabetes seem to be similarly important prognostic risk factors for ACS patients.

Table 1. Cumulative clinical outcomes up to 10-year between hypertension group and diabetes group
Entire patientsPropensity score-matched patientsHazard ratio (95% CI)p value
VariablesHypertension (n=1,108)Diabetes (n=236)p valueHypertension (n=236)Diabetes (n=236)p value
Total death, n (%)60 (5.4)14 (5.9)0.7529 (3.8)14 (5.9)0.2850.62 (0.27–1.43)0.267
Cardiac death, n (%)40 (3.6)10 (4.2)0.6444 (1.7)10 (4.2)0.1040.39 (0.12–1.24)0.110
Myocardial infarction (MI), n (%)53 (4.8)9 (3.8)0.51910 (4.2)9 (3.8)0.8151.08 (0.43–2.65)0.871
ST-segment elevation MI, n (%)32 (2.9)6 (2.5)0.7713 (1.3)6 (2.5)0.3130.49 (0.12–1.96)0.312
Revascularizations, n (%)147 (13.3)30 (12.7)0.81930 (12.7)30 (12.7)NS2.37 (1.22–4.60)0.011
TLR, n (%)83 (7.5)17 (7.2)0.87916 (6.8)17 (7.2)0.8570.85 (0.42–1.71)0.647
TVR, n (%)104 (9.4)20 (8.5)0.66019 (8.1)20 (8.5)0.8670.87 (0.46–1.66)0.678
Non-TVR, n (%)61 (5.5)16 (6.8)0.44417 (7.2)16 (6.8)0.8570.66 (0.32–1.37)0.269
MACEs, n (%)191 (17.2)42 (17.8)0.83737 (15.7)42 (17.8)0.5380.85 (0.55–1.33)0.483

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