CLINICAL STUDY
effects of coronary stenting on vessel patency and long-term clinical outcome after percutaneous coronary revascularization in diabetic patients
Eric Van Belle, MD, PhD, FACC* ,*,
Marc Périé, MD*,
David Braune, MD*,
Akram Chmaït, MD*,
Thibaud Meurice, MD*,
Kaveh Abolmaali, MD*,
Eugène P. McFadden, FRCPI, FACC*,
Christophe Bauters, MD, FACC*,
Jean-Marc Lablanche, MD, FACC* and
Michel E. Bertrand, MD, FACC
* Centre Hospitalier Régional, Lille, France
University of Lille, Lille, France
Manuscript received October 10, 2001;
revised manuscript received March 27, 2002,
accepted April 30, 2002.
* Reprint requests and correspondence: Dr. Eric Van Belle, Hôpital Cardiologique, Centre Hospitalier Régional, Boulevard du Professeur J. Leclercq, 59037 Lille Cedex, France.
ericvanbelle{at}aol.com
OBJECTIVES: We sought to compare coronary stent implantation with balloon angioplasty (BA), in a diabetic population, in terms of the six-month angiographic outcome and four-year clinical events.
BACKGROUND: Diabetic patients have a poor angiographic and clinical outcome after standard coronary BA. To date, it is still unclear whether stent implantation may improve this outcome.
METHODS: We investigated this issue by individual matching of 314 diabetic patients treated with either coronary stenting or standard BA. These two groups were derived from a population of consecutive diabetic patients (1993 to 1996). Matching criteria were gender, anti-diabetic regimen, stenosis location, reference diameter, and minimal luminal diameter (±0.4 mm). One lesion per patient was considered for matching.
RESULTS: Baseline characteristics were similar between the two groups of 157 patients. At six months, the rates of restenosis (27% vs. 62%; p < 0.0001) and occlusion (4% vs. 13%; p < 0.005) were lower in the stent group than in the BA group. This was associated with a significant decrease in ejection fraction at six months in the BA group (p = 0.02) while, during the same period, no change was observed in the stent group (p = NS). Subgroup analysis demonstrated that angiographic benefit was consistent among the subgroups. At four years, the combined clinical end point of cardiac death and non-fatal myocardial infarction was lower in the stent group (14.8% vs. 26.0%; p = 0.02), as was the need for repeat revascularization (35.4% vs. 52.1%; p = 0.001).
CONCLUSIONS: In a population of diabetic patients, coronary stent implantation was associated with a highly beneficial effect on the six-month angiographic outcome and four-year clinical events compared with standard BA.
|
Abbreviations and Acronyms
| | ARTS | | Arterial Revascularization Therapy Study | | BA | | balloon angioplasty | | EPISTENT | | Evaluation of Platelet IIb/IIIa Inhibitor for Stenting | | LV | | left ventricular, left ventricle | | LVEF | | left ventricular ejection fraction | | MI | | myocardial infarction | | MLD | | minimal luminal diameter | | PCR | | percutaneous coronary revascularization | | PTCA | | percutaneous transluminal coronary angioplasty | | SVG | | saphenous vein graft | | TIMI | | Thrombolysis in Myocardial Infarction trial |
|
This article has been cited by other articles:
|
|
|
|
 
M. Billinger, J. Beutler, K. R. Taghetchian, A. Remondino, P. Wenaweser, S. Cook, M. Togni, C. Seiler, C. Stettler, F. R. Eberli, et al.
Two-year clinical outcome after implantation of sirolimus-eluting and paclitaxel-eluting stents in diabetic patients
Eur. Heart J.,
March 2, 2008;
29(6):
718 - 725.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Jimenez-Quevedo, M. Sabate, D. J. Angiolillo, F. Alfonso, R. Hernandez-Antolin, M. SanMartin, J. A. Gomez-Hospital, C. Banuelos, J. Escaned, R. Moreno, et al.
Long-term clinical benefit of sirolimus-eluting stent implantation in diabetic patients with de novo coronary stenoses: long-term results of the DIABETES trial
Eur. Heart J.,
August 2, 2007;
28(16):
1946 - 1952.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F Boccara, E Teiger, and A Cohen
Role of drug eluting stents in diabetic patients
Heart,
May 1, 2006;
92(5):
579 - 581.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Susen, K. Sautiere, F. Mouquet, F. Cuilleret, A. Chmait, E. P. McFadden, B. Hennache, F. Richard, P. de Groote, J.-M. Lablanche, et al.
Serum hepatocyte growth factor levels predict long-term clinical outcome after percutaneous coronary revascularization
Eur. Heart J.,
November 2, 2005;
26(22):
2387 - 2395.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Franklin, R. J. Goldberg, F. Spencer, W. Klein, A. Budaj, D. Brieger, M. Marre, P. G. Steg, N. Gowda, J. M. Gore, et al.
Implications of Diabetes in Patients With Acute Coronary Syndromes: The Global Registry of Acute Coronary Events
Arch Intern Med,
July 12, 2004;
164(13):
1457 - 1463.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. R Timmer, J. P. Ottervanger, K. Thomas, J. C.A Hoorntje, M.-J. de Boer, H. Suryapranata, F. Zijlstra, and on behalf of the Zwolle myocardial infarction stud
Long-term, cause-specific mortality after myocardial infarction in diabetes
Eur. Heart J.,
June 1, 2004;
25(11):
926 - 931.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. W. Vetrovec
Don't blame the stents
J. Am. Coll. Cardiol.,
April 21, 2004;
43(8):
1355 - 1357.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. E.J. West, P. N. Ruygrok, C. M.C. Disco, M. W.I. Webster, W. K. Lindeboom, W. W. O'Neill, N. F. Mercado, and P. W. Serruys
Clinical and Angiographic Predictors of Restenosis After Stent Deployment in Diabetic Patients
Circulation,
February 24, 2004;
109(7):
867 - 873.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Mathew, B. J. Gersh, B. A. Williams, W. K. Laskey, J. T. Willerson, R. T. Tilbury, B. R. Davis, and D. R. Holmes Jr
Outcomes in Patients With Diabetes Mellitus Undergoing Percutaneous Coronary Intervention in the Current Era: A Report From the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) Trial
Circulation,
February 3, 2004;
109(4):
476 - 480.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Abizaid, M. A. Costa, D. Blanchard, M. Albertal, H. Eltchaninoff, G. Guagliumi, L. Geert-Jan, A. S. Abizaid, A. G.M.R. Sousa, E. Wuelfert, et al.
Sirolimus-eluting stents inhibit neointimal hyperplasia in diabetic patients: Insights from the RAVEL Trial
Eur. Heart J.,
January 2, 2004;
25(2):
107 - 112.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. V. Desouza, S. N. Murthy, J. Diez, B. Dunne, A. S. Matta, V. A. Fonseca, and D. B. McNamara
Differential Effects of Peroxisome Proliferator Activator Receptor-{alpha} and {gamma} Ligands on Intimal Hyperplasia After Balloon Catheter-Induced Vascular Injury in Zucker Rats
Journal of Cardiovascular Pharmacology and Therapeutics,
December 1, 2003;
8(4):
297 - 305.
[Abstract]
[PDF]
|
|
|
|
|
|
|
K. Stephenson, J. Tunstead, A. Tsai, R. Gordon, S. Henderson, and H. M. Dansky
Neointimal Formation After Endovascular Arterial Injury Is Markedly Attenuated in db/db Mice
Arterioscler. Thromb. Vasc. Biol.,
November 1, 2003;
23(11):
2027 - 2033.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K.-H. Mak and D. P. Faxon
Clinical studies on coronary revascularization in patients with type 2 diabetes
Eur. Heart J.,
June 2, 2003;
24(12):
1087 - 1103.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. E. Sousa, P. W. Serruys, and M. A. Costa
New Frontiers in Cardiology: Drug-Eluting Stents: Part II
Circulation,
May 13, 2003;
107(18):
2383 - 2389.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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]
|
|
|
|
