Outcomes Among Diabetic Patients Undergoing Percutaneous Coronary Intervention With Contemporary Drug-Eluting Stents: Analysis From the BIONICS Randomized Trial

Maayan Konigstein, Ori Ben-Yehuda, Pieter C. Smits, Michael P. Love, Shmuel Banai, Gidon Y. Perlman, Mordechai Golomb, Melek Ozgu Ozan, Mengdan Liu, Martin B. Leon, Gregg W. Stone, David E. Kandzari

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: The authors sought to investigate the impact of diabetes mellitus (DM) on outcomes following contemporary drug-eluting stent (DES) implantation in the BIONICS (BioNIR Ridaforolimus Eluting Coronary Stent System in Coronary Stenosis) trial. Background: Patients with DM are at increased risk for adverse events following percutaneous coronary intervention (PCI). Methods: A prospective, multicenter, 1:1 randomized trial was conducted to evaluate in a noninferiority design the safety and efficacy of ridaforolimus-eluting stents versus zotarolimus-eluting stents among 1,919 patients undergoing PCI. Randomization was stratified to the presence of medically treated DM, and a pre-specified analysis compared outcomes according to the presence or absence of DM up to 2 years. Results: The overall prevalence of DM was 29.1% (559 of 1,919). DM patients had higher body mass index, greater prevalence of hyperlipidemia and hypertension, and smaller reference vessel diameter. One-year target lesion failure (cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization) was significantly higher among diabetic patients (7.8% vs. 4.2%; p = 0.002), mainly due to higher target lesion revascularization (4.5% vs. 2.0%; p = 0.002). Rates of cardiac death, myocardial infarction, and stent thrombosis did not statistically vary. Among 158 patients undergoing 13-month angiographic follow-up, restenosis rates were 3 times higher in diabetic patients compared with nondiabetic patients (15.2% vs. 4.7%; p = 0.01). Clinical and angiographic outcomes were similar between ridaforolimus-eluting stent– and zotarolimus-eluting stent–treated patients. Conclusions: Despite advances in interventional therapies, and the implementation of new-generation DES, diabetic patients still have worse angiographic and clinical outcomes compared with nondiabetic patients undergoing PCI.

Original languageEnglish
Pages (from-to)2467-2476
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume11
Issue number24
DOIs
StatePublished - 24 Dec 2018
Externally publishedYes

Keywords

  • clinical outcomes
  • diabetes
  • percutaneous coronary intervention
  • ridaforolimus-eluting stent(s)

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