This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mehran, R. Articles by Leon, M. B. Search for Related Content PubMed PubMed Citation Articles by Mehran, R. Articles by Leon, M. B.

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

This article has been cited by other articles:

				P. Wenaweser, J. Daemen, M. Zwahlen, R. van Domburg, P. Juni, S. Vaina, G. Hellige, K. Tsuchida, C. Morger, E. Boersma, et al. Incidence and Correlates of Drug-Eluting Stent Thrombosis in Routine Clinical Practice: 4-Year Results From a Large 2-Institutional Cohort Study J. Am. Coll. Cardiol., September 30, 2008; 52(14): 1134 - 1140. [Abstract] [Full Text] [PDF]

				N. Sasaki, T. Yamashita, T. Takaya, M. Shinohara, R. Shiraki, M. Takeda, N. Emoto, A. Fukatsu, T. Hayashi, K. Ikemoto, et al. Augmentation of Vascular Remodeling by Uncoupled Endothelial Nitric Oxide Synthase in a Mouse Model of Diabetes Mellitus Arterioscler. Thromb. Vasc. Biol., June 1, 2008; 28(6): 1068 - 1076. [Abstract] [Full Text] [PDF]

				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]

				J. M. Wilson and J. T. Willerson Myocardial Revascularization with Percutaneous Devices Card. Surg. Adult, January 1, 2008; 3(2008): 573 - 598. [Full Text]

				A. Javaid, D. H. Steinberg, A. N. Buch, P. J. Corso, S. W. Boyce, T. L. Pinto Slottow, P. K. Roy, P. Hill, T. Okabe, R. Torguson, et al. Outcomes of Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention With Drug-Eluting Stents for Patients With Multivessel Coronary Artery Disease Circulation, September 11, 2007; 116(11_suppl): I-200 - I-206. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. V. d. Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur. Heart J. Suppl., June 1, 2007; 9(suppl_C): C3 - C74. [Full Text] [PDF]

				Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. Van den Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur. Heart J., January 1, 2007; 28(1): 88 - 136. [Full Text] [PDF]

				M. Thielmann, R. Leyh, P. Massoudy, M. Neuhauser, I. Aleksic, M. Kamler, U. Herold, J. Piotrowski, and H. Jakob Prognostic Significance of Multiple Previous Percutaneous Coronary Interventions in Patients Undergoing Elective Coronary Artery Bypass Surgery Circulation, July 4, 2006; 114(1_suppl): I-441 - I-447. [Abstract] [Full Text] [PDF]

				S. Srivastava, K. V. Ramana, R. Tammali, S. K. Srivastava, and A. Bhatnagar Contribution of aldose reductase to diabetic hyperproliferation of vascular smooth muscle cells. Diabetes, April 1, 2006; 55(4): 901 - 910. [Abstract] [Full Text] [PDF]

				T. F. Christian Anatomy of an Emerging Diagnostic Test: Computed Tomographic Coronary Angiography Circulation, October 11, 2005; 112(15): 2222 - 2225. [Full Text] [PDF]

				S. B. King III, G. Dangas, J. W. Moses, S. B. King III, G. Dangas, and J. W. Moses Surgery Is Preferred for the Diabetic With Multivessel Disease Circulation, September 6, 2005; 112(10): 1500 - 1515. [Full Text] [PDF]

				H. S. Gurm, I. J. Sarembock, D. J. Kereiakes, J. J. Young, R. A. Harrington, N. Kleiman, F. Feit, K. Wolski, J. A. Bittl, R. Wilcox, et al. Use of Bivalirudin During Percutaneous Coronary Intervention in Patients With Diabetes Mellitus: An Analysis From the Randomized Evaluation in Percutaneous Coronary Intervention Linking Angiomax to Reduced Clinical Events (REPLACE)-2 Trial J. Am. Coll. Cardiol., June 21, 2005; 45(12): 1932 - 1938. [Abstract] [Full Text] [PDF]

				J. Molnar, S. Yu, N. Mzhavia, C. Pau, I. Chereshnev, and H. M. Dansky Diabetes Induces Endothelial Dysfunction but Does Not Increase Neointimal Formation in High-Fat Diet Fed C57BL/6J Mice Circ. Res., June 10, 2005; 96(11): 1178 - 1184. [Abstract] [Full Text] [PDF]

				A. V. Finn, I. F. Palacios, A. Kastrati, and H. K. Gold Drug-eluting stents for diabetes mellitus: A rush to judgment? J. Am. Coll. Cardiol., February 15, 2005; 45(4): 479 - 483. [Abstract] [Full Text] [PDF]