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 revascu-larization 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.