Diabetes Mellitus and Long-Term Risk for Heart Failure After Coronary Revascularization
Yasuaki Takeji, Hiroki Shiomi, Takeshi Morimoto, Yutaka Furukawa, Natsuhiko Ehara, Yoshihisa Nakagawa, Takao Kato, Junichi Tazaki, Eri Kato, Hidenori Yaku, Yusuke Yoshikawa, Tomohisa Tada, Michiya Hanyu, Kazushige Kadota, Tatsuhiko Komiya, Kenji Andò, Takeshi Kimura, CREDO-Kyoto PCI/CABG Registry Cohort Investigators
Abstract
BACKGROUND: The effect of diabetes mellitus (DM) status on the long-term risk for heart failure (HF) in patients undergoing coronary revascularization has not been adequately evaluated. METHODS AND RESULTS: In this study, 15,231 patients who underwent coronary revascularization in the CREDO-Kyoto Registry Cohort-2 were divided into 2 groups according to DM status (DM group: n=5,999; Non-DM group: n=9,232). The DM group was further divided into 2 groups according to insulin treatment (insulin-treated DM [ITDM]: n=1,353; non-insulin-treated DM [NITDM]: n=4,646). The primary outcome measure was HF hospitalization. The cumulative 5-year incidence of HF hospitalization was significantly higher in the DM than non-DM group (11.0% vs. 6.6%, respectively; log-rank P<0.0001), and in the ITDM than NITDM group (14.6% vs. 10.0%, respectively; log-rank P<0.0001). After adjusting for confounders, the increased risk of HF hospitalization with DM relative to non-DM remained significant (hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.30-1.67, P<0.0001), whereas the risk associated with ITDM relative to NITDM was not significant (HR 1.17, 95% CI 0.96-1.43, P=0.12). CONCLUSIONS: The adjusted long-term risk for HF hospitalization after coronary revascularization was significantly higher in DM than non-DM patients, regardless of revascularization strategy, but did not differ between ITDM and NITDM patients.