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J Am Coll Cardiol, 1998; 32:584-589
© 1998 by the American College of Cardiology Foundation
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CLINICAL STUDIES

The influence of diabetes mellitus on acute and late clinical outcomes following coronary stent implantation

Alexandre Abizaid, MDa, Ran Kornowski, MDa, Gary S. Mintz, MD, FACCa, Mun K. Hong, MD, FACCa, Andrea S. Abizaid, MDa, Roxana Mehran, MDa, Augusto D. Pichard, MD, FACCa, Kenneth M. Kent, MD, PhD, FACCa, Lowell F. Satler, MD, FACCa, Hongsheng Wu, PhDa, Jeffrey J. Popma, MD, FACCa and Martin B. Leon, MD, FACCa

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 event–free 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 event–free survival rate. On the other hand, acute and long-term procedural outcome was found to be similar for non-IDDM compared with nondiabetic patients.

Abbreviations and Acronyms
  CSA = cross-sectional area
  CSN = cross-sectional narrowing
  EEM = external elastic membrane
  IDDM = insulin-dependent diabetes mellitus
  IVUS = intravascular ultrasound
  MLD = minimum lumen diameter
  P + M = plaque + media
  PTCA = balloon angioplasty
  TLR = target lesion revascularization




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