The long-term (7-year) outcomes of 454 diabetic patients (20.6 % ) randomized to PCI or MED in the Occluded Artery Trial (OAT) were assessed for the composite primary endpoint of death, re-MI, or New York Heart Association class IV heart failure. Diabetics and non-diabetics were compared and outcomes assessed by treatment strategy.
The 7-year cumulative primary event rate for diabetic patients was 35.0 % vs. 19.4 % in the non-diabetic cohort (p < 0.001). Multivariable analyses revealed diabetes to be an independent predictor (p < 0.01) for the primary outcome, fatal or nonfatal recurrent MI, Class IV Heart Failure (HF), and death. The 7-year cumulative primary event rates were 35.3 % in the PCI group vs. 34.5 % in the medical therapy group in diabetic patients (p = 0.19) and 19.3 % in the PCI group vs. 19.5 % in the medical therapy group in patients without diabetes (p = 0.60).
Despite the higher overall risk conferred by the presence of diabetes, PCI did not improve clinical outcomes in this subpopulation, and is not indicated in otherwise stable patients with a totally occluded infarct-related artery in the sub-acute phase after MI.