Anna Grodzinsky1, Mikhail Kosiborod2, Fengming Tang2, Philip G Jones2, Darren K McGuire2, John A Spertus2, John F Beltrame2, Jae-Sik Jang2, Abhinav Goyal2, Neel M Butala2, Robert W Yeh2, Suzanne V Arnold2. 1. From the Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G., M.K., F.T., P.G.J., J.A.S., J.-S.J., S.V.A.); University of Missouri-Kansas City (A.G., M.K., J.A.S., S.V.A.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Australia (J.F.B.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.); Massachusetts General Hospital Department of Medicine, Boston, MA (N.M.B.); and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (R.W.Y.). grodzinskya@umkc.edu. 2. From the Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G., M.K., F.T., P.G.J., J.A.S., J.-S.J., S.V.A.); University of Missouri-Kansas City (A.G., M.K., J.A.S., S.V.A.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Australia (J.F.B.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.); Massachusetts General Hospital Department of Medicine, Boston, MA (N.M.B.); and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (R.W.Y.).
Abstract
BACKGROUND: Previous studies suggest that among patients with stable coronary artery disease, patients with diabetes mellitus (DM) have less angina and more silent ischemia when compared with those without DM. However, the burden of angina in diabetic versus nondiabetic patients after elective percutaneous coronary intervention (PCI) has not been recently examined. METHODS AND RESULTS: In a 10-site US PCI registry, we assessed angina before and at 1, 6, and 12 months after elective PCI with the Seattle Angina Questionnaire angina frequency score (range, 0-100, higher=better). We also examined the rates of antianginal medication prescriptions at discharge. A multivariable, repeated-measures Poisson model was used to examine the independent association of DM with angina over the year after treatment. Among 1080 elective PCI patients (mean age, 65 years; 74.7% men), 34.0% had DM. At baseline and at each follow-up, patients with DM had similar angina prevalence and severity as those without DM. Patients with DM were more commonly prescribed calcium channel blockers and long-acting nitrates at discharge (DM versus not: 27.9% versus 20.9% [P=0.01] and 32.8% versus 25.5% [P=0.01], respectively), whereas β-blockers and ranolazine were prescribed at similar rates. In the multivariable, repeated-measures model, the risk of angina was similar over the year after PCI in patients with versus without DM (relative risk, 1.04; range, 0.80-1.36). CONCLUSIONS: Patients with stable coronary artery disease and DM exhibit a burden of angina that is at least as high as those without DM despite more antianginal prescriptions at discharge. These findings contradict the conventional teachings that patients with DM experience less angina because of silent ischemia.
BACKGROUND: Previous studies suggest that among patients with stable coronary artery disease, patients with diabetes mellitus (DM) have less angina and more silent ischemia when compared with those without DM. However, the burden of angina in diabetic versus nondiabeticpatients after elective percutaneous coronary intervention (PCI) has not been recently examined. METHODS AND RESULTS: In a 10-site US PCI registry, we assessed angina before and at 1, 6, and 12 months after elective PCI with the Seattle Angina Questionnaire angina frequency score (range, 0-100, higher=better). We also examined the rates of antianginal medication prescriptions at discharge. A multivariable, repeated-measures Poisson model was used to examine the independent association of DM with angina over the year after treatment. Among 1080 elective PCI patients (mean age, 65 years; 74.7% men), 34.0% had DM. At baseline and at each follow-up, patients with DM had similar angina prevalence and severity as those without DM. Patients with DM were more commonly prescribed calcium channel blockers and long-acting nitrates at discharge (DM versus not: 27.9% versus 20.9% [P=0.01] and 32.8% versus 25.5% [P=0.01], respectively), whereas β-blockers and ranolazine were prescribed at similar rates. In the multivariable, repeated-measures model, the risk of angina was similar over the year after PCI in patients with versus without DM (relative risk, 1.04; range, 0.80-1.36). CONCLUSIONS:Patients with stable coronary artery disease and DM exhibit a burden of angina that is at least as high as those without DM despite more antianginal prescriptions at discharge. These findings contradict the conventional teachings that patients with DM experience less angina because of silent ischemia.
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