Lopez-de-Andres Ana, Jimenez-García Rodrigo, Hernandez-Barrera Valentin, Perez-Farinos Napoleon, de Miguel-Yanes Jose M, Mendez-Bailon Manuel, Jimenez-Trujillo Isabel, de Miguel Angel Gil, Pino Carmen Gallardo, Carrasco-Garrido Pilar
Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain.
Cardiovasc Diabetol. 2014 Jan 3;13:3. doi: 10.1186/1475-2840-13-3.
Diabetes is associated with a high risk of death due to coronary artery disease (CAD). People with diabetes suffering from CAD are frequently treated with revascularization procedures. We aim to compare trends in the use and outcomes of coronary revascularization procedures in diabetic and non-diabetic patients in Spain between 2001 and 2011.
We identified all patients who had undergone coronary revascularization procedures, percutaneous coronary interventions (PCI) and coronary artery bypass graft (CABG) surgeries, using national hospital discharge data. Discharges were grouped by diabetes status: type 2 diabetes and no diabetes. The incidence of discharges attributed to coronary revascularization procedures were calculated stratified by diabetes status. We calculated length of stay and in-hospital mortality (IHM). We apply joinpoint log-linear regression to identify the years in which changes in tendency occurred in the use of PCI and CABG in diabetic and non-diabetic patients. Multivariate analysis was adjusted by age, sex, year and comorbidity (Charlson comorbidity index).
From 2001 to 2011, 434,108 PCIs and 79,986 CABGs were performed. According to the results of the joinpoint analysis, we found that sex and age-adjusted use of PCI increased by 31.4% per year from 2001 to 2003, by 15.9% per year from 2003 to 2006 and by 3.8% per year from 2006 to 2011 in patients with diabetes. IHM among patients with diabetes who underwent a PCI did not change significantly over the entire study period (OR 0.99; 95% CI 0.97-1.00).Among patients with diabetes who underwent a CABG, the sex and age-adjusted CABG incidence rate increased by 10.4% per year from 2001 to 2003, and then decreased by 1.1% through 2011. Diabetic patients who underwent a CABG had a 0.67 (95% CI 0.63-0.71) times lower probability of dying during hospitalization than those without diabetes.
The annual percent change in PCI procedures increased in diabetic and non-diabetic patients. Higher comorbidity and the female gender are associated with a higher IHM in PCI procedures. In diabetic and non-diabetic patients, we found a decrease in the use of CABG procedures. IHM was higher in patients without diabetes than in those with diabetes.
糖尿病与冠状动脉疾病（CAD）导致的高死亡风险相关。患有CAD的糖尿病患者常接受血运重建术治疗。我们旨在比较2001年至2011年西班牙糖尿病患者和非糖尿病患者冠状动脉血运重建术的使用趋势及结果。
我们利用国家医院出院数据，确定了所有接受冠状动脉血运重建术、经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）手术的患者。出院情况按糖尿病状态分组：2型糖尿病和无糖尿病。计算按糖尿病状态分层的冠状动脉血运重建术出院发生率。我们计算了住院时间和院内死亡率（IHM）。我们应用连接点对数线性回归来确定糖尿病患者和非糖尿病患者使用PCI和CABG发生趋势变化的年份。多变量分析按年龄、性别、年份和合并症（查尔森合并症指数）进行调整。
2001年至2011年，共进行了434,108例PCI和79,986例CABG。根据连接点分析结果，我们发现，2001年至2003年，糖尿病患者经性别和年龄调整后的PCI使用量每年增加31.4%，2003年至2006年每年增加15.9%，2006年至2011年每年增加3.8%。在整个研究期间，接受PCI的糖尿病患者的IHM没有显著变化（比值比0.99；95%置信区间0.97 - 1.00）。在接受CABG的糖尿病患者中，2001年至2003年经性别和年龄调整后的CABG发生率每年增加10.4%，然后到2011年下降了1.1%。接受CABG的糖尿病患者住院期间死亡的概率比未患糖尿病的患者低0.67倍（95%置信区间0.63 - 0.71）。
糖尿病患者和非糖尿病患者PCI手术的年度百分比变化均有所增加。合并症较高和女性在PCI手术中与较高的IHM相关。在糖尿病患者和非糖尿病患者中，我们发现CABG手术的使用有所减少。无糖尿病患者的IHM高于糖尿病患者。
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