A comparative analysis of major clinical outcomes using drug-eluting stents versus bare metal stents in diabetic versus nondiabetic patients

Sa'Ar Minha, Tamir Bental, Abid Assali, Hana Vaknin-Assa, Eli I. Lev, Eldad Rechavia, Alexander Battler, Ran Kornowski

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: We aim to explore the clinical outcome of drug-eluting stents (DES) versus bare-metal stents (BMS) implantation in diabetics versus nondiabetic patients. Background: Diabetic patients sustain worse long-term clinical outcomes after percutaneous coronary interventions (PCI) when compared with nondiabetics. The use of DES decreases the rate of repeat revascularization in this population but data concerning long-term clinical benefits, such as myocardial infarction (MI) or mortality is scant. Methods: We analyzed data from a comprehensive registry of 6,583 consecutive patients undergoing PCI at our center. A propensity score was used for analysis of outcomes and for matching (DES vs. BMS). Outcome parameters were total mortality, MI, repeat target vessel revascularization (TVR) rates, and risk-adjusted event-free survival. Within this cohort, we identified 2,571 nondiabetic patients and these were compared with 1,826 diabetic coronary patients. Results: Mean and median follow up time was 3 and 3.25 years, respectively. Overall, diabetics had higher rates of major-adverse cardiovascular events (MACE) at 4 years compared with nondiabetics (23.03 vs. 31.96 P > 0.001). DES use was associated with lower rates of TVR in both groups [diabetics hazard ratio (HR) = 0.56, 95% confidence interval (CI): 0.42-0.76, P < 0.001, nondiabetics HR = 0.73, 95% CI: 0.55-0.97, P = 0.03] while sustained decreased rates of both mortality and MI were evident solely among diabetics (HR = 0.71, 95% CI: 0.56-0.89, P = 0.004 in diabetic vs. HR = 0.88, 95% CI: 0.69-1.13, P = 0.3). Conclusions: In a "real-world, " unselected population and extended clinical use, DES in diabetics was associated with sustained decreased rates of MI, death, TVR, and MACE while this benefit was attenuated in the nondiabetic population.

Original languageEnglish
Pages (from-to)710-717
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume78
Issue number5
DOIs
StatePublished - 1 Nov 2011

Keywords

  • coronary artery disease
  • diabetes mellitus
  • drug-eluting stent
  • percutaneous coronary intervention

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