Assessment of medical management in Coronary Type 2 Diabetic patients with previous percutaneous coronary intervention in Spain: A retrospective analysis of electronic health records using Natural Language Processing.
oleh: Carlos González-Juanatey, Manuel Anguita-Sá Nchez, Vivencio Barrios, Iván Núñez-Gil, Juan Josá Gómez-Doblas, Xavier García-Moll, Carlos Lafuente-Gormaz, María Jesús Rollán-Gómez, Vicente Peral-Disdie, Luis Martínez-Dolz, Miguel Rodríguez-Santamarta, Xavier Viñolas-Prat, Toni Soriano-Colomé, Roberto Muñoz-Aguilera, Ignacio Plaza, Alejandro Curcio-Ruigómez, Ernesto Orts-Soler, Javier Segovia, Claudia Maté, SAVANA Research Group, Ángel Cequier
| Format: | Article |
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| Diterbitkan: | Public Library of Science (PLoS) 2022-01-01 |
Deskripsi
<h4>Introduction and objectives</h4>Patients with type 2 diabetes (T2D) and stable coronary artery disease (CAD) previously revascularized with percutaneous coronary intervention (PCI) are at high risk of recurrent ischemic events. We aimed to provide real-world insights into the clinical characteristics and management of this clinical population, excluding patients with a history of myocardial infarction (MI) or stroke, using Natural Language Processing (NLP) technology.<h4>Methods</h4>This is a multicenter, retrospective study based on the secondary use of 2014-2018 real-world data captured in the Electronic Health Records (EHRs) of 1,579 patients (0.72% of the T2D population analyzed; n = 217,632 patients) from 12 representative hospitals in Spain. To access the unstructured clinical information in EHRs, we used the EHRead® technology, based on NLP and machine learning. Major adverse cardiovascular events (MACE) were considered: MI, ischemic stroke, urgent coronary revascularization, and hospitalization due to unstable angina. The association between MACE rates and the variables included in this study was evaluated following univariate and multivariate approaches.<h4>Results</h4>Most patients were male (72.13%), with a mean age of 70.5±10 years. Regarding T2D, most patients were non-insulin-dependent T2D (61.75%) with high prevalence of comorbidities. The median (Q1-Q3) duration of follow-up was 1.2 (0.3-4.5) years. Overall, 35.66% of patients suffered from at least one MACE during follow up. Using a Cox Proportional Hazards regression model analysis, several independent factors were associated with MACE during follow up: CAD duration (p < 0.001), COPD/Asthma (p = 0.021), heart valve disease (p = 0.031), multivessel disease (p = 0.005), insulin treatment (p < 0.001), statins treatment (p < 0.001), and clopidogrel treatment (p = 0.039).<h4>Conclusions</h4>Our results showed high rates of MACE in a large real-world series of PCI-revascularized patients with T2D and CAD with no history of MI or stroke. These data represent a potential opportunity to improve the clinical management of these patients.