Abstract
Background
Drug‐eluting stents (DES) have been shown in randomized trials to reduce clinical events in diabetic patients. Our aim was to determine whether these clinical results are applicable in an unselected population of patients with non‐insulin‐dependent diabetes mellitus (NIDDM) and insulin‐dependent diabetes mellitus (IDDM).
Methods
We studied 440 consecutive patients (271 NIDDM and 169 IDDM) who underwent percutaneous coronary intervention, divided into 2 cohorts: Group A (1998–2000): 220 patients with bare metal stents, and Group B (2002–2004): 220 patients with drug‐eluting stents. We analyzed major coronary adverse events (death, nonfatal acute myocardial infarction, and target lesion revascularization) over a mean follow‐up of 18 ± 15 months.
Results
Group B had more patients who were insulin‐dependent (44.5 versus 32.3% p<0.001) or had hypertension (64.5 versus 54.1%; p = 0.02), a lower left ventricular ejection fraction (53.89 versus 56.8%; p = 0.04), more complex lesions (B2/C) (82.7 versus 62.3%; p<0.001), more treated lesions (1.40 versus 1.26; p<0.001), more stents implanted (1.69 versus 1.15; p<0.0001), and more patients treated with abciximab (76.8 versus 42.7%; p<0.0001). During the follow‐up, Group B had fewer major adverse coronary events (11.7 versus 27.9%; p<0.001) and a reduction in target lesion revascularization (3.9 versus 17.2%; p<0.001), with no differences in death or myocardial infarction. Both groups experienced a significant reduction in events (NIDDM: 8.1 versus 26.7%; p<0.001 and IDDM: 16 versus 31.9%; p = 0.016). Multivariate regression analysis showed the use of drug‐eluting stents to be in direct relation with event‐free survival (odds ratio [OR]: 3.37; 95% confidence interval [CI], 1.44–7.90; p = 0.005).
Conclusion
Despite the worse angiographic characteristics, the use of DES reduced clinical events, particularly target lesion revascularization. Copyright © 2008 Wiley Periodicals, Inc.
Keywords: diabetes mellitus, revascularization, drug‐eluting stents, prognosis
Full Text
The Full Text of this article is available as a PDF (105.3 KB).
References
- 1. Stein B, Weintraub WS, Gebhart SP, Cohen‐Bernstein CL, Grosswald R, et al.: Influence of diabetes mellitus on early and late outcome after percutaneous trasluminal coronary angioplasty. Circulation 1995; 91: 979–989. [DOI] [PubMed] [Google Scholar]
- 2. Carozza JP, Ho KK, Neimann D, Kuntz RE, Cutlip DE: Diabetes mellitus is associated with adverse 6 month angiographic and clinical outcome following coronary stenting. Circulation 1998; 98: I–79. [Google Scholar]
- 3. Abizaid A, Kornowski R, Mintz GS, Hong MK, Abizaid AS, et al.: The influence of diabetes mellitus on acute and late clinical outcomes following coronary stent implantation. J Am Coll Cardiol 1998; 32: 584–589. [DOI] [PubMed] [Google Scholar]
- 4. Pascual Figal D, Valdés Chavarri M, García Almagro F, Garzón Rodríguez A, González Carrillo J, et al.: Impact of diabetes mellitus on the late clinical outcome of coronary revascularization with stents. Rev Esp Cardiol 2001; 54: 261–268. [PubMed] [Google Scholar]
- 5. Jiménez Navarro M, Curiel E, Hernández García JM, Alonso Briales J, Domínguez Franco A, et al.: Influence of diabetes mellitus on clinical outcome after percutaneous coronary revascularization. Rev Esp Cardiol 2002; 55: 365–371. [DOI] [PubMed] [Google Scholar]
- 6. Silva JA, Escobar A, Collins TJ, Ramee SR, White CJ: Unstable angina. A comparison of angioscopic findings between diabetic and non diabetic patients. Circulation 1995; 92: 1731–1736. [DOI] [PubMed] [Google Scholar]
- 7. Werner GS, Richartz BM, Heinke S, Ferrari M, Figulla HR: Impaired acute collateral recruitment as a possible mechanism for increased cardiac adverse events in patients with diabetes mellitus. Eur Heart J 2003; 24: 1134–1142. [DOI] [PubMed] [Google Scholar]
- 8. Roffi M, Topol EJ: Percutaneous coronary interventions in diabetic patients with non‐ST segment elevation acute coronary syndromes. Eur Heart J 2004; 25: 190–198. [DOI] [PubMed] [Google Scholar]
- 9. Sarembock I: Stent restenosis and the use of drug‐eluting stents in patients with diabetes mellitus. Curr Diab Rep 2004; 4: 13–19. [DOI] [PubMed] [Google Scholar]
- 10. Moussa I, Leon MB, Baim DS, O Neil WW, Popma JJ, et al.: Impact of sirolimus‐eluting stents on outcome in diabetic patients. A SIRIUS (sirolimus‐coated Bx velocity ballon‐expandible stent in the treatment of patients with the novo coronary artery lesions) substudy. Circulation 2004; 109: 2273–2278. [DOI] [PubMed] [Google Scholar]
- 11. Stone GW, Ellis S, Cox D, Hermiller J, Shaughnessy C, et al.: A polymer‐based Paclitaxel stent in patients with coronary artery disease. N Engl J Med 2004; 350: 221–331. [DOI] [PubMed] [Google Scholar]
- 12. Sabaté M, Jiménez‐Quevedo P, Angiolillo DJ, Gómez‐Hospital JA, Alfonso F, et al.: Randomized comparison of sirolimus‐eluting stent versus standard stent for percutaneous coronary revascularization in diabetic patients. The Diabetes and Sirolimus‐Eluting Stent (DIABETES) Trial. Circulation 2005; 112: 2175–2183. [DOI] [PubMed] [Google Scholar]
- 13. de la Torre Hernández JM, Sainz Laso F, Ruisánchez C, Zueco J, Figueroa A, et al.: Treatment of lesions with a high risk of stenosis. Comparative study in 300 patients of rapamycin‐ and Paclitaxel‐eluting polymer‐based stents, and bare metal stents. Rev Esp Cardiol 2005; 58: 262–269. [PubMed] [Google Scholar]
- 14. Berenguer A, Mainar V, Bordes P, Valencia J, Gómez S: Efficacy of sirolimus‐eluting stents in diabetics with complex coronary lesions. Rev Esp Cardiol 2006; 59: 117–124. [PubMed] [Google Scholar]
- 15. Sabaté M: Insulin‐Dependent. Rapamycin‐Resistant? Rev Esp Cardiol 2006; 59: 91–93. [PubMed] [Google Scholar]
- 16. Stone GW, Ellis S, Cox D, Hermiller J, O'Shaughnessy C, et al.: One‐year clinical results with the slow‐release, polymer‐based, paclitaxel‐eluting TAXUS stent. The TAXUS‐IV Trial. Circulation 2004; 109: 1942–1947. [DOI] [PubMed] [Google Scholar]
- 17. Lemos PA, Serruys PW, Van Domburg RT, Saia F, Arampatzis CA, et al.: Unrestricted utilization of sirolimus‐eluting stents compared with conventional bare stent implantation in the “real world”. Circulation 2004; 109: 190–195. [DOI] [PubMed] [Google Scholar]
- 18. Hernández JM, Domínguez A, Jiménez‐Navarro MF, Alonso JH, Curiel E, et al.: Does abciximab improve the prognosis of diabetics after percutaneous coronary intervention? Rev Esp Cardiol 2002; 55: 810–815. [PubMed] [Google Scholar]
- 19. Marso SP, Lincoff M, Ellis S, Bhatt D, Tanguay JF, et al.: Optimizing the percutaneous interventional outcomes for diabetic patients with diabetes mellitus. Results of the EPISTENT Diabetic Substudy. Circulation 1999; 100: 2477–2484. [DOI] [PubMed] [Google Scholar]
- 20. Chaves AJ, Sousa AG, Mattos L, Abizaid A, Staico R, et al.: Volumetric analysis of in‐stent intimal hyperplasia in diabetic patients treated with or without abciximab. Results of the DANTE Trial. Circulation 2004; 109: 861–866. [DOI] [PubMed] [Google Scholar]
- 21. Dibra A, Kastrati A, Mehilli J, Pache J, Schuhlen H, et al.: Paclitaxel‐eluting or sirolimus‐eluting stents to prevent restenosis in diabetic patients. N Engl J Med 2005; 353: 663–670. [DOI] [PubMed] [Google Scholar]