Coronary angiography in the very old: impact of diabetes on long-term revascularization and mortality

Background Diabetes is often associated with coronary artery disease, leading to adverse clinical outcomes. Real-world data is limited regarding the impact of diabetes in very old patients undergoing coronary angiography on the risk for late or repeated coronary revascularization and mortality. Methods Retrospective analysis of 1,353 consecutive patients ≥ 80 years who were admitted to the cardiac unit and further underwent coronary angiography. Subsequent revascularization procedures and all-cause mortality were recorded over a median follow-up of 47 months and their relation to diabetic status and presentation with acute coronary syndrome(ACS) was studied. Results Diabetes was present in 31% of the patients undergoing coronary angiography, and was associated with higher rates of obesity, hypertension, hyperlipidemia, chronic kidney disease and female gender. ACS was the presenting diagnosis in 71% of the patients and was associated with worse survival(1-year mortality 20% in ACS vs. 6.2% in non-ACS patients, P < 0.0001). Increase in long-term mortality rates was seen in diabetic subjects compared to non-diabetic subjects presenting with ACS(log-rank P = 0.005), but not in the non-ACS setting(P = 0.199). In a multivariable model, additionally adjusting for acuity of presentation, the presence of diabetes was associated with an adjusted hazard ratio of 1.60(95% confidence interval: 1.12–2.28), P = 0.011, for the need of late or repeat coronary revascularization and 1.48(1.26–1.74), P < 0.0001 for all-cause mortality, during long-term follow-up. Conclusions In very old patients undergoing coronary angiography, presentation with ACS was associated with worse survival. Diabetes was an independent predictor of late or repeated revascularization and long-term mortality.