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.
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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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January 16, 2002;
39(2):
183 - 193.
[Abstract]
[Full Text]
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H. Hase, N. Joki, M. Nakamura, T. Tsunoda, Y. Tanaka, M. Fukazawa, Y. Takahashi, Y. Imamura, R. Nakamura, and T. Yamaguchi
Favourable long-term outcome by repeated percutaneous coronary revascularization in diabetic haemodialysis patients
Nephrol. Dial. Transplant.,
January 1, 2002;
17(1):
100 - 105.
[Abstract]
[Full Text]
[PDF]
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E. Erdmann
Cardiovascular events in patients with type 2 diabetes
The British Journal of Diabetes & Vascular Disease,
January 1, 2002;
2(1_suppl):
S4 - S8.
[Abstract]
[PDF]
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F. J. Th. Wackers and B. L. Zaret
Detection of Myocardial Ischemia in Patients With Diabetes Mellitus
Circulation,
January 1, 2002;
105(1):
5 - 7.
[Full Text]
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P. J. Pugh, L. O'Toole, K. S. Channer, D. P. Taggart, A. Banning, K. Channon, M. J. Mack, M. Murtaza, M. Singh, L. Dharmarajan, et al.
Coronary-Artery Bypass Surgery versus Stenting for Multivessel Disease
N. Engl. J. Med.,
November 29, 2001;
345(22):
1641 - 1643.
[Full Text]
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A. Abizaid, M. A. Costa, M. Centemero, A. S. Abizaid, V. M.G. Legrand, R. V. Limet, G. Schuler, F. W. Mohr, W. Lindeboom, A. G.M.R. Sousa, et al.
Clinical and Economic Impact of Diabetes Mellitus on Percutaneous and Surgical Treatment of Multivessel Coronary Disease Patients: Insights From the Arterial Revascularization Therapy Study (ARTS) Trial
Circulation,
July 31, 2001;
104(5):
533 - 538.
[Abstract]
[Full Text]
[PDF]
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S. B. King III
Coronary artery bypass graft or percutaneous coronary interventions in patients with diabetes: another nail in the coffin or "too close to call?"
J. Am. Coll. Cardiol.,
March 15, 2001;
37(4):
1016 - 1018.
[Full Text]
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R. Hoffmann and G.S. Mintz
Coronary in-stent restenosis--predictors, treatment and prevention
Eur. Heart J.,
November 1, 2000;
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1739 - 1749.
[PDF]
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J. M. Ahmed, M. K. Hong, R. Mehran, G. Dangas, G. S. Mintz, A. D. Pichard, L. F. Satler, K. M. Kent, H. Wu, G. W. Stone, et al.
Influence of diabetes mellitus on early and late clinical outcomes in saphenous vein graft stenting
J. Am. Coll. Cardiol.,
October 1, 2000;
36(4):
1186 - 1193.
[Abstract]
[Full Text]
[PDF]
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T. Hammoud, J.-F. Tanguay, and M. G. Bourassa
Management of coronary artery disease: therapeutic options in patients with diabetes
J. Am. Coll. Cardiol.,
August 1, 2000;
36(2):
355 - 365.
[Abstract]
[Full Text]
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D. Hasdai, C. B. Granger, S. S. Srivatsa, D. A. Criger, S. G. Ellis, R. M. Califf, E. J. Topol, and D. R. Holmes Jr.
Diabetes mellitus and outcome after primary coronary angioplasty for acute myocardial infarction: lessons from the GUSTO-IIb angioplasty substudy
J. Am. Coll. Cardiol.,
May 1, 2000;
35(6):
1502 - 1512.
[Abstract]
[Full Text]
[PDF]
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J. Schofer, M. Schluter, T. Rau, F. Hammer, N. Haag, and D. G. Mathey
Influence of treatment modality on angiographic outcome after coronary stenting in diabetic patients: a controlled study
J. Am. Coll. Cardiol.,
May 1, 2000;
35(6):
1554 - 1559.
[Abstract]
[Full Text]
[PDF]
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D. L. Bhatt, S. P. Marso, A. M. Lincoff, K. E. Wolski, S. G. Ellis, and E. J. Topol
Abciximab reduces mortality in diabetics following percutaneous coronary intervention
J. Am. Coll. Cardiol.,
March 15, 2000;
35(4):
922 - 928.
[Abstract]
[Full Text]
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S. B. King III and E. Mahmud
Will Blocking the Platelet Save the Diabetic?
Circulation,
December 21, 1999;
100(25):
2466 - 2468.
[Full Text]
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S. P. Marso, A. M. Lincoff, S. G. Ellis, D. L. Bhatt, J.-F. Tanguay, N. S. Kleiman, T. Hammoud, J. E. Booth, S. K. Sapp, and E. J. Topol
Optimizing the Percutaneous Interventional Outcomes for Patients With Diabetes Mellitus : Results of the EPISTENT (Evaluation of Platelet IIb/IIIa Inhibitor for Stenting Trial) Diabetic Substudy
Circulation,
December 21, 1999;
100(25):
2477 - 2484.
[Abstract]
[Full Text]
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R. Mehran, G. Dangas, A. S. Abizaid, G. S. Mintz, A. J. Lansky, L. F. Satler, A. D. Pichard, K. M. Kent, G. W. Stone, and M. B. Leon
Angiographic Patterns of In-Stent Restenosis : Classification and Implications for Long-Term Outcome
Circulation,
November 2, 1999;
100(18):
1872 - 1878.
[Abstract]
[Full Text]
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Worse Stent Outcome in Insulin-Dependent Diabetics
Journal Watch Cardiology,
October 9, 1998;
1998(1009):
6 - 6.
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