ABSTRACT
BACKGROUND: Type I and type II diabetes mellitus (DM) patients have a higher prevalence of cardiovascular diseases, as well as a higher mortality risk of cardiovascular diseases and interventions. This study provides an update on the impact of DM on clinical outcomes, including mortality, complications and reinterventions, using data on percutaneous and surgical cardiac interventions in the Netherlands. METHODS: This is a retrospective, nearby nationwide study using real-world observational data registered by the Netherlands Heart Registration (NHR) between 2015 and 2020. Patients treated for combined or isolated coronary artery disease (CAD) and aortic valve disease (AVD) were studied. Bivariate analyses and multivariate logistic regression models were used to evaluate the association between DM and clinical outcomes both unadjusted and adjusted for baseline characteristics. RESULTS: 241,360 patients underwent the following interventions; percutaneous coronary intervention(N = 177,556), coronary artery bypass grafting(N = 39,069), transcatheter aortic valve implantation(N = 11,819), aortic valve replacement(N = 8,028) and combined CABG and AVR(N = 4,888). The incidence of DM type I and II was 21.1%, 26.7%, 17.8%, 27.6% and 27% respectively. For all procedures, there are statistically significant differences between patients living with and without diabetes, adjusted for baseline characteristics, at the expense of patients with diabetes for 30-days mortality after PCI (OR = 1.68; p <.001); 120-days mortality after CABG (OR = 1.35; p <.001), AVR (OR = 1.5; p <.03) and CABG + AVR (OR = 1.42; p =.02); and 1-year mortality after CABG (OR = 1.43; p <.001), TAVI (OR = 1.21; p =.01) and PCI (OR = 1.68; p <.001). CONCLUSION: Patients with DM remain to have unfavourable outcomes compared to nondiabetic patients which calls for a critical reappraisal of existing care pathways aimed at diabetic patients within the cardiovascular field.
Subject(s)
Coronary Artery Bypass , Coronary Artery Disease , Diabetes Mellitus, Type 1 , Diabetes Mellitus, Type 2 , Percutaneous Coronary Intervention , Registries , Transcatheter Aortic Valve Replacement , Humans , Male , Female , Aged , Retrospective Studies , Treatment Outcome , Percutaneous Coronary Intervention/mortality , Percutaneous Coronary Intervention/adverse effects , Risk Factors , Time Factors , Coronary Artery Disease/mortality , Coronary Artery Disease/therapy , Coronary Artery Disease/surgery , Middle Aged , Risk Assessment , Aged, 80 and over , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/mortality , Netherlands/epidemiology , Diabetes Mellitus, Type 2/mortality , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/therapy , Transcatheter Aortic Valve Replacement/adverse effects , Transcatheter Aortic Valve Replacement/mortality , Diabetes Mellitus, Type 1/mortality , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/therapy , Incidence , Aortic Valve Disease/surgery , Aortic Valve Disease/mortality , Postoperative Complications/mortality , Hospitals, High-VolumeABSTRACT
We report on a 75-year-old man with a history of metastatic prostate cancer who presented with haematuria, peripheral oedema, metabolic alkalosis, hypokalaemia, and hypertension. Laboratory evaluation was compatible with the diagnosis of adrenocorticotropic hormone (ACTH)-dependent cushing's syndrome and suggestive of ectopic ACTH production. Pathology of a prostate biopsy specimen showed a large cell neuroendocrine carcinoma (LCNEC) of the prostate. This report describes a case of Cushing's syndrome that was probably caused by ectopic ACTH secretion by a LCNEC of the prostate.