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J Am Coll Cardiol, 1998; 32:1866-1873
© 1998 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Diabetes mellitus and the clinical and angiographic outcome after coronary stent placement

Shpend Elezi, MDa, Adnan Kastrati, MDa, J.ürgen Pache, MDa, Anne Wehinger, MDa, Martin Hadamitzky, MDa, Josef Dirschinger, MDa, Franz-Josef Neumann, MDa and Albert Schömig, MDa

a Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Technische Universität München, Munich, Germany

Manuscript received May 20, 1998; revised manuscript received July 28, 1998, accepted August 20, 1998.

Address for correspondence: Dr. Adnan Kastrati, Deutsches Herzzentrum München, Lazarettstr. 36, 80636 München, Germany
kastrati{at}dhm.mhn.de

Objectives. The objectives of this study were to analyze the clinical and angiographic outcome of diabetic patients with successful coronary stent placement and to compare these results with those achieved after stenting in nondiabetic patients.

Background. The outcome of diabetic patients treated with stent placement due to coronary artery disease has not been assessed comprehensively.

Methods. This study analyzes a consecutive series of patients with successful stent placement comprising 715 patients with diabetes and 2,839 patients without diabetes. Clinical one year follow-up and angiographic control at 6 months were part of the protocol. Death, myocardial infarction and target lesion revascularization were considered as adverse events. An automated edge detection system was used for the angiographic assessment. The primary clinical endpoint was event-free survival at one year. The primary angiographic endpoint was restenosis rate at 6 months (≥50% diameter stenosis).

Results. Event-free survival was significantly lower in diabetic than in nondiabetic patients (73.1 vs. 78.5%, p < 0.001). Survival free of myocardial infarction was also significantly reduced in the diabetic group (89.9 vs. 94.4% in nondiabetics, p < 0.001). The incidence of both restenosis (37.5 vs. 28.3%, p < 0.001) and stent vessel occlusion (5.3 vs. 3.4%, p = 0.037) was significantly higher in diabetic patients. Diabetes was identified as an independent risk factor for adverse clinical events and restenosis in multivariate analyses.

Conclusions. Patients with diabetes mellitus have a less favorable clinical outcome at one year after successful stent placement as compared to the nondiabetic patients. The clinical follow-up was characterized by a higher incidence of death, myocardial infarction and reinterventions. Diabetic patients also demonstrated an increased risk for restenosis.

Abbreviations and Acronyms
  CABG = aortocoronary bypass surgery
  CART = classification and regression tree
  MACE = major adverse cardiovascular events
  MLD = minimal lumen diameter
  PTCA = percutaneous transluminal coronary angioplasty




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E. Van Belle, M. Perie, D. Braune, A. Chmait, T. Meurice, K. Abolmaali, E. P. McFadden, C. Bauters, J.-M. Lablanche, and M. E. Bertrand
effects of coronary stenting on vessel patency and long-term clinical outcome after percutaneous coronary revascularization in diabetic patients
J. Am. Coll. Cardiol., August 7, 2002; 40(3): 410 - 417.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
V. Mathew and D. R. Holmes
Outcomes in diabetics undergoing revascularization: The long and the short of it
J. Am. Coll. Cardiol., August 7, 2002; 40(3): 424 - 427.
[Full Text] [PDF]

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 CirculationHome page
M. Roffi, D. J. Moliterno, B. Meier, E. R. Powers, C. L. Grines, P. M. DiBattiste, H. C. Herrmann, M. Bertrand, K. E. Harris, L. A. Demopoulos, et al.
Impact of Different Platelet Glycoprotein IIb/IIIa Receptor Inhibitors Among Diabetic Patients Undergoing Percutaneous Coronary Intervention: Do Tirofiban and ReoPro Give Similar Efficacy Outcomes Trial (TARGET) 1-Year Follow-Up
Circulation, June 11, 2002; 105(23): 2730 - 2736.
[Abstract] [Full Text] [PDF]

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 JAMAHome page
J. A. Beckman, M. A. Creager, and P. Libby
Diabetes and Atherosclerosis: Epidemiology, Pathophysiology, and Management
JAMA, May 15, 2002; 287(19): 2570 - 2581.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
R. O. Bonow, W. E. Mitch, R. W. Nesto, P. T. O'Gara, R. C. Becker, L. T. Clark, S. Hunt, I. Jialal, S. E. Lipshultz, and E. Loh
Prevention Conference VI: Diabetes and Cardiovascular Disease: Writing Group V: Management of Cardiovascular-Renal Complications
Circulation, May 7, 2002; 105 (18): e159 - e164.
[Full Text] [PDF]

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 CirculationHome page
S. C. Smith Jr, D. Faxon, W. Cascio, H. Schaff, T. Gardner, A. Jacobs, S. Nissen, and R. Stouffer
Prevention Conference VI: Diabetes and Cardiovascular Disease: Writing Group VI: Revascularization in Diabetic Patients
Circulation, May 7, 2002; 105 (18): e165 - e169.
[Full Text] [PDF]

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 Nephrol Dial TransplantHome page
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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 British Journal of Diabetes & Vascular DiseaseHome page
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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 CirculationHome page
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.
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 NEJMHome page
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] [PDF]

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 J Am Coll CardiolHome page
E. Jorgensen, H. Kelbaek, S. Helqvist, G. V. H. Jensen, K. Saunamaki, J. Kastrup, O. Havndrup, H. Bundgaard, J. Kyst Madsen, M. Christiansen, et al.
Predictors of coronary in-stent restenosis: importance of angiotensin-converting enzyme gene polymorphism and treatment with angiotensin-converting enzyme inhibitors
J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1434 - 1439.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
S.-H. Park, S. P. Marso, Z. Zhou, F. Foroudi, E. J. Topol, and A. M. Lincoff
Neointimal Hyperplasia After Arterial Injury Is Increased in a Rat Model of Non-Insulin-Dependent Diabetes Mellitus
Circulation, August 14, 2001; 104(7): 815 - 819.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
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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 J Am Coll CardiolHome page
A. Moustapha, A. R. Assali, S. Sdringola, W. K. Vaughn, R. D. Fish, O. Rosales, G. Schroth, Z. Krajcer, R. W. Smalling, and H. V. Anderson
Percutaneous and surgical interventions for in-stent restenosis: long-term outcomes and effect of diabetes mellitus
J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1877 - 1882.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
E. Van Belle, R. Ketelers, C. Bauters, M. Perie, K. Abolmaali, F. Richard, J.-M. Lablanche, E. P. McFadden, and M. E. Bertrand
Patency of Percutaneous Transluminal Coronary Angioplasty Sites at 6-Month Angiographic Follow-Up : A Key Determinant of Survival in Diabetics After Coronary Balloon Angioplasty
Circulation, March 6, 2001; 103(9): 1218 - 1224.
[Abstract] [Full Text] [PDF]

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 HeartHome page
U E Heidland, M P Heintzen, C J Michel, and B E Strauer
Risk factors for the development of restenosis following stent implantation of venous bypass grafts
Heart, March 1, 2001; 85(3): 312 - 317.
[Abstract] [Full Text]

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 Eur Heart JHome page
S.N Willich, J Muller-Nordhorn, M Kulig, S Binting, H Gohlke, H Hahmann, K Bestehorn, K Krobot, and H Voller
Cardiac risk factors, medication, and recurrent clinical events after acute coronary disease. A prospective cohort study
Eur. Heart J., February 2, 2001; 22(4): 307 - 313.
[Abstract] [PDF]

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 NEJMHome page
M. B. Leon, P. S. Teirstein, J. W. Moses, P. Tripuraneni, A. J. Lansky, S. Jani, S. C. Wong, D. Fish, S. Ellis, D. R. Holmes, et al.
Localized Intracoronary Gamma-Radiation Therapy to Inhibit the Recurrence of Restenosis after Stenting
N. Engl. J. Med., January 25, 2001; 344(4): 250 - 256.
[Abstract] [Full Text] [PDF]

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 Eur Heart JHome page
R. Hoffmann and G.S. Mintz
Coronary in-stent restenosis--predictors, treatment and prevention
Eur. Heart J., November 1, 2000; 21(21): 1739 - 1749.
[PDF]

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 J Am Coll CardiolHome page
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] [PDF]

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 Cardiovasc ResHome page
J. H. Baron, A. H. Gershlick, K. Hogrefe, J. Armstrong, C. M. Holt, R. K. Aggarwal, M. Azrin, M. Ezekowitz, and D. P. de Bono
In vitro evaluation of c7E3-Fab (ReoProTM) eluting polymer-coated coronary stents
Cardiovasc Res, June 1, 2000; 46(3): 585 - 594.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
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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 CirculationHome page
S. B. King III and E. Mahmud
Will Blocking the Platelet Save the Diabetic?
Circulation, December 21, 1999; 100(25): 2466 - 2468.
[Full Text] [PDF]

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 CirculationHome page
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] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
R. W. Emery, K. V. Arom, T. F. Flavin, and A. M. Emery
A case for minimally invasive coronary surgery as primary treatment for left anterior descending coronary artery disease
Eur. J. Cardiothorac. Surg., November 1, 1999; 16(suppl_2): S112 - S116.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
P. R. Moreno, J. T. Fallon, A. M. Murcia, M. N. Leon, H. Simosa, V. Fuster, and I. F. Palacios
Tissue characteristics of restenosis after percutaneous transluminal coronary angioplasty in diabetic patients
J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1045 - 1049.
[Abstract] [Full Text] [PDF]


 
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