학술논문
Modifiers of the Risk of Diabetes for Long-Term Outcomes After Coronary Revascularization: CREDO-Kyoto PCI/CABG Registry.
Document Type
Academic Journal
Author
Yamaji K; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.; Shiomi H; Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.; Morimoto T; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.; Matsumura-Nakano Y; Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.; Ehara N; Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.; Sakamoto H; Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan.; Takeji Y; Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.; Yoshikawa Y; Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.; Yamamoto K; Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.; Kato ET; Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.; Imada K; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.; Tada T; Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.; Taniguchi R; Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.; Nishikawa R; Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan.; Tada T; Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan.; Uegaito T; Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan.; Ogawa T; Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada, Japan.; Yamada M; Department of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan.; Takeda T; Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan.; Eizawa H; Department of Cardiology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan.; Tamura N; Department of Cardiovascular Surgery, Kindai University Nara Hospital, Ikoma, Japan.; Tambara K; Department of Cardiovascular Surgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan.; Suwa S; Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan.; Shirotani M; Department of Cardiology, Kindai University Nara Hospital, Ikoma, Japan.; Tamura T; Department of Cardiology, Tenri Hospital, Tenri, Japan.; Inoko M; Department of Cardiology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.; Nishizawa J; Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu, Japan.; Natsuaki M; Department of Cardiovascular Medicine, Saga University, Saga, Japan.; Sakai H; Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan.; Yamamoto T; Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan.; Kanemitsu N; Department of Cardiovascular Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.; Ohno N; Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.; Ishii K; Department of Cardiology, Kansai Denryoku Hospital, Osaka, Japan.; Marui A; Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan.; Tsuneyoshi H; Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan.; Terai Y; Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan.; Nakayama S; Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Japan.; Yamazaki K; Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.; Takahashi M; Department of Cardiology, Shimabara Hospital, Kyoto, Japan.; Tamura T; Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.; Esaki J; Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan.; Miki S; Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan.; Onodera T; Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan.; Mabuchi H; Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan.; Furukawa Y; Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.; Tanaka M; Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan.; Komiya T; Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan.; Soga Y; Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan.; Hanyu M; Department of Cardiovascular Surgery, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.; Domei T; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.; Ando K; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.; Kadota K; Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.; Minatoya K; Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.; Nakagawa Y; Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan.; Kimura T; Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Source
Publisher: Elsevier on behalf of the American College of Cardiology Foundation Country of Publication: United States NLM ID: 9918452380106676 Publication Model: eCollection Cited Medium: Internet ISSN: 2772-3747 (Electronic) Linking ISSN: 27723747 NLM ISO Abbreviation: JACC Asia Subsets: PubMed not MEDLINE
Subject
Language
English
Abstract
Background: Diabetes is a well-known risk factor for adverse outcomes after coronary revascularization.
Objectives: This study sought to determine high-risk subgroups in whom the excess risks of diabetes relative to nondiabetes are particularly prominent and thus may benefit from more aggressive interventions.
Methods: The study population consisted of 39,427 patients (diabetes: n = 15,561; nondiabetes: n = 23,866) who underwent first percutaneous coronary intervention (n = 33,144) or coronary artery bypass graft (n = 6,283) in the pooled CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Graft) registry. The primary outcome measure was major adverse cardiovascular and cerebral endpoints (MACCE), which was defined as a composite of all-cause death, myocardial infarction, and stroke.
Results: With median follow-up of 5.6 years, diabetes was associated with significantly higher adjusted risks for MACCE. The excess adjusted risks of diabetes relative to nondiabetes for MACCE increased with younger age (≤64 years: adjusted HR: 1.30; 95% CI: 1.19-1.41; P < 0.001; 64-73 years: adjusted HR: 1.24; 95% CI: 1.16-1.33; P < 0.001; >73 years: adjusted HR: 1.17; 95% CI: 1.10-1.23; P < 0.001; Pinteraction < 0.001), mainly driven by greater excess adjusted mortality risk of diabetes relative to nondiabetes in younger tertile. No significant interaction was observed between adjusted risk of diabetes relative to nondiabetes for MACCE and other subgroups such as sex, mode of revascularization, and clinical presentation of acute myocardial infarction.
Conclusions: The excess risk of diabetes relative to nondiabetes for MACCE was profound in the younger population. This observation suggests more aggressive interventions for secondary prevention in patients with diabetes might be particularly relevant in younger patients.
Competing Interests: This study was supported by an educational grant from the Research Institute for Production Development (Kyoto, Japan). Dr Yamaji has received a research grant from Abbott Vascular. Dr Shiomi has received honoraria from Abbott Vascular and Boston Scientific. Dr Morimoto has received lecturer's fees from Bristol-Myers Squibb, Daiichi Sankyo, Japan Lifeline, Kowa, Kyocera, Novartis, and Toray; manuscript fees from Bristol-Myers Squibb and Kowa; and has served on the Advisory Board of Sanofi. Dr Ehara has received honoraria from Abbott Vascular, Bayer, Boston Scientific, Medtronic, and Terumo. Dr Furukawa has received honoraria from Bayer, Kowa, and Sanofi. Dr Nakagawa has received research grants from Abbott Vascular and Boston Scientific; and honoraria from Abbott Vascular, Bayer, and Boston Scientific. Dr Kimura has received a research grant from Abbott Vascular; and honoraria from Astellas, AstraZeneca, Bayer, Boston Scientific, Kowa, and Sanofi. All the other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(© 2022 The Authors.)
Objectives: This study sought to determine high-risk subgroups in whom the excess risks of diabetes relative to nondiabetes are particularly prominent and thus may benefit from more aggressive interventions.
Methods: The study population consisted of 39,427 patients (diabetes: n = 15,561; nondiabetes: n = 23,866) who underwent first percutaneous coronary intervention (n = 33,144) or coronary artery bypass graft (n = 6,283) in the pooled CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Graft) registry. The primary outcome measure was major adverse cardiovascular and cerebral endpoints (MACCE), which was defined as a composite of all-cause death, myocardial infarction, and stroke.
Results: With median follow-up of 5.6 years, diabetes was associated with significantly higher adjusted risks for MACCE. The excess adjusted risks of diabetes relative to nondiabetes for MACCE increased with younger age (≤64 years: adjusted HR: 1.30; 95% CI: 1.19-1.41; P < 0.001; 64-73 years: adjusted HR: 1.24; 95% CI: 1.16-1.33; P < 0.001; >73 years: adjusted HR: 1.17; 95% CI: 1.10-1.23; P < 0.001; P
Conclusions: The excess risk of diabetes relative to nondiabetes for MACCE was profound in the younger population. This observation suggests more aggressive interventions for secondary prevention in patients with diabetes might be particularly relevant in younger patients.
Competing Interests: This study was supported by an educational grant from the Research Institute for Production Development (Kyoto, Japan). Dr Yamaji has received a research grant from Abbott Vascular. Dr Shiomi has received honoraria from Abbott Vascular and Boston Scientific. Dr Morimoto has received lecturer's fees from Bristol-Myers Squibb, Daiichi Sankyo, Japan Lifeline, Kowa, Kyocera, Novartis, and Toray; manuscript fees from Bristol-Myers Squibb and Kowa; and has served on the Advisory Board of Sanofi. Dr Ehara has received honoraria from Abbott Vascular, Bayer, Boston Scientific, Medtronic, and Terumo. Dr Furukawa has received honoraria from Bayer, Kowa, and Sanofi. Dr Nakagawa has received research grants from Abbott Vascular and Boston Scientific; and honoraria from Abbott Vascular, Bayer, and Boston Scientific. Dr Kimura has received a research grant from Abbott Vascular; and honoraria from Astellas, AstraZeneca, Bayer, Boston Scientific, Kowa, and Sanofi. All the other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(© 2022 The Authors.)