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J Am Coll Cardiol, 1998; 32:584-589 © 1998 by the American College of Cardiology Foundation |
a Cardiac Catheterization Laboratories, The Washington Hospital Center, Washington, DC, USA
Manuscript received February 19, 1998; revised manuscript received May 13, 1998, accepted May 20, 1998.
Address for correspondence: Martin B. Leon, MD, Director, Cardiovascular Research, Washington Cardiology Center, 110 Irving Street NW, Suite 4B1, Washington, DC 20010
MBL1{at}mhg.edu
Objectives. We compared the clinical outcomes following coronary stent implantation in insulin-treated diabetes mellitus (IDDM), non-IDDM patients, and nondiabetic patients.
Background. Diabetic patients have increased restenosis and late morbidity following balloon angioplasty. The impact of diabetes mellitus (DM), especially IDDM, on in-stent restenosis is not known.
Methods. We studied 954 consecutive patients with native coronary artery lesions treated with elective Palmaz-Schatz stents implantation using conventional coronary angiographic and intravascular ultrasound methodology. Procedural success, major in-hospital complications, and 1-year clinical outcome were compared according to the diabetic status.
Results. In-hospital mortality was 2% in IDDM, significantly higher (p <0.02) compared with non-IDDM (0%) and nondiabetics (0.3%). Stent thrombosis did not differ among groups (0.9% in IDDM vs. 0% in non-IDDM and 0% in nondiabetics, p >0.1). During follow-up, target lesion revascularization (TLR) was 28% in IDDM, significantly higher (p <0.05) compared with non-IDDM (17.6%) and nondiabetics (16.3%). Late cardiac eventfree survival (including death, myocardial infarction [MI], and any coronary revascularization procedure) was significantly lower (p = 0.0004) in IDDM (60%) compared with non-IDDM (70%) and nondiabetic patients (76%). By multivariate analysis, IDDM was an independent predictor for any late cardiac event (OR = 2.05, p = 0.0002) in general and TLR (odds ratio = 2.51, p = 0.0001) in particular.
Conclusions. In a large consecutive series of patients treated by elective stent implantation, IDDM patients were at higher risk for in-hospital mortality and subsequent TLR and, as a result, had a significantly lower cardiac eventfree survival rate. On the other hand, acute and long-term procedural outcome was found to be similar for non-IDDM compared with nondiabetic patients.
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