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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Short- and long-term results after multivessel stenting in diabetic patients

^* Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York, USA

Manuscript received July 29, 2002; revised manuscript received March 28, 2003, accepted April 4, 2003.

^* Reprint requests and correspondence: Dr. George D. Dangas, Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, 55 East 59th Street, 6th Floor, New York, New York 10022, USA.
gdangas{at}crf.org

OBJECTIVES: The present study evaluated clinical outcomes in diabetic patients after multivessel stenting.

BACKGROUND: Multivessel angioplasty studies have reported decreased survival in diabetic patients undergoing conventional balloon angioplasty compared with coronary artery bypass graft surgery (CABG). However, several studies have demonstrated excellent procedural success and acceptable clinical outcomes after multivessel stenting.

METHODS: Multivessel stenting was performed in 689 patients with 1,639 native coronary lesions. Patients were classified into three groups according to diabetes mellitus (DM) status: 1) no DM (501 patients/1,200 lesions); 2) DM treated with oral agents (102 patients/235 lesions); and 3) DM treated with insulin (86 patients/204 lesions).

RESULTS: Procedural success was high overall. In-hospital CABG was higher in diabetics treated with insulin compared with the other two groups (3.5% vs. 0.4% vs. 1.0%, p = 0.02). There were no significant differences in the incidence of in-hospital cardiac death and myocardial infarction. Diabetic patients treated with oral agents or insulin had higher one-year target lesion revascularization rates than non-diabetic patients (25% vs. 35% vs. 16%, p < 0.001). Lower one-year survival was observed in diabetic patients treated with either oral agents or insulin, compared with non-diabetic patients (85% vs. 86% vs. 95%, p < 0.001). On multivariable analysis, DM was an independent predictor of one-year mortality, myocardial infarction, and target lesion revascularization after multivessel stenting.

CONCLUSIONS: Despite a high technical success rate of multivessel stenting, diabetic patients, especially those treated with insulin, have higher in-hospital CABG, higher subsequent revascularization rates, and lower one-year survival than non-diabetic patients.

Abbreviations and Acronyms   BARI = Bypass Angioplasty Revascularization Investigation   CABG = coronary artery bypass graft surgery   DM = diabetes mellitus   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty   QMI = Q-wave myocardial infarction   TLR = target lesion revascularization

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