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CLINICAL STUDIES

The importance of proteinuria as a determinant of mortality following percutaneous coronary revascularization in diabetics

^a Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received May 29, 1998; revised manuscript received December 1, 1998, accepted January 11, 1999.

Reprint requests and correspondence: Dr. Steven P. Marso, Department of Cardiology/F25, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195
marsos{at}cesmtp.ccf.org

OBJECTIVES

The aims of this study were to compare mortality and clinical events following percutaneous coronary intervention (PCI) between nondiabetics and diabetics with and without proteinuria.

BACKGROUND

Diabetics have increased rates of late myocardial infarction, repeat revascularization and mortality when compared with nondiabetics following PCI. Proteinuria is a marker for diabetic nephropathy and potentially a surrogate marker for advanced atherosclerosis. It is unknown if proteinuria is a predictor of outcome in diabetics following PCI.

METHODS

We performed an observational study of 2,784 patients who underwent PCI at the Cleveland Clinic between January 1993 and December 1995. There were 2,247 nondiabetics and 537 diabetics with urinalysis and follow-up data available (proteinuria n = 217, nonproteinuria n = 320). The diabetic proteinuria group was further prospectively stratified into low concentration (n = 182) and high concentration (n = 35). The end points were all-cause mortality and the composite end point of death, nonfatal myocardial infarction (MI) and need for revascularization.

RESULTS

The mean follow-up time was 20.2 months. The two-year mortality rate was 7.3% and 13.5% for nondiabetics and diabetics, respectively (p < 0.001). The two-year mortality rate was 9.1% and 20.3% for the nonproteinuria and proteinuria groups, respectively (p < 0.001). There was a graded increase in mortality comparing the diabetic group. The two-year mortality rate was 9.1%, 16.2% and 43.1% for the nonproteinuria, low concentration and high concentration groups, respectively (p < 0.001). The difference in survival between the nondiabetic and nonproteinuric diabetics was not significant (p = 0.8).

CONCLUSIONS

The presence of proteinuria is the key determinant of risk following PCI for diabetics. Diabetics without evidence of proteinuria have similar survival compared with nondiabetics.

Abbreviations and Acronyms   ACE = angiotensin converting enzyme   CABG = coronary artery bypass grafting   LVEF = left ventricular ejection fraction   MI = myocardial infarction   PCI = percutaneous coronary intervention

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