Long-term oral nitrate therapy is associated with adverse outcome in diabetic patients following elective percutaneous coronary intervention

BACKGROUND: To assess the impact of long-term oral nitrate therapy on clinical outcome following percutaneous coronary intervention (PCI) in patients with type II diabetes. METHODS: The incidence of major adverse cardiovascular events (MACEs) following elective PCI for stable coronary artery disease was evaluated in 108 patients with type II diabetes (age 64.6 ± 10.5 years, 67.7% men). Major adverse cardiovascular events were defined as the need for revascularization, non-fatal myocardial infarction or cardiovascular death. Multivariate Cox regression analysis was used to evaluate the predictive value of MACEs by clinical characteristics and the prescription of long-term nitrate therapy. RESULTS: Isosorbide mononitrate (ISMN) was prescribed to 46 patients with an average dose of 44.3 ± 15.2 mg/day. After a mean follow up of 25.3 ± 25 months, 16 patients developed MACEs. Patients who received ISMN were more likely to suffer from MACEs (26.1% vs. 6.5%, P = 0.01), mainly driven by a higher rate of acute coronary syndrome (13.0 vs 0%, P = 0.01). Average daily dose of nitrate and other cardiovascular medication was not associated with MACEs. Multivariate Cox regression analysis revealed that prescription of only ISMN (Hazard Ratio 3.09, 95% CI 1.10-10.21, P = 0.04) was an independent predictor for the development of MACEs. CONCLUSION: Long-term oral nitrate therapy was associated with MACEs following elective coronary artery revascularization by PCI in patients with type II diabetes.