Differences in clinical and angiographic outcomes with different drug-eluting stents in Japanese patients with and without diabetes mellitus

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• 作者：Tetsuya Sato ; MD ; PhD ; ^{tesato@ta3.so-net.ne.jp} ; Tamaki Ono ; MD ; Yoshimasa Morimoto ; MD ; Haruaki Kawai ; MD ; Soichiro Fuke ; MD ; PhD ; Tetsuya Ikeda ; MD ; PhD ; Hironori Saito ; MD ; PhD ; FJCC
• 关键词：Drug-eluting stent ; Prognosis ; Diabetes ; Major adverse cardiac events
• 刊名：Journal of Cardiology
• 出版年：2012
• 出版时间：November, 2012
• 年：2012
• 卷：60
• 期：5
• 页码：361-366
• 全文大小：200 K

文摘

Background

Although percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) is associated with worse clinical outcomes, the efficacy of drug-eluting stents (DES) in Japanese patients and differences in effectiveness between different DES types remain unknown.

Methods and subjects

Five-hundred and sixty-two consecutive patients (183 with DM, 379 without DM) with 676 lesions were treated with sirolimus-eluting stents (SES, m>nm> = 531; 160 DM group, 371 non-DM group) or paclitaxel-eluting stents (PES, m>nm> = 145; 64 and 81, respectively). We assessed the initial and 8-month follow-up clinical and angiographic outcomes.

Results

There were no significant differences in clinical and lesion characteristics, although the pre-minimum luminal diameter was smaller in the DM group (m>pm> = 0.016). The risk of major adverse cardiac events (MACE), defined as cardiac death, non-fatal myocardial infarction, congestive heart failure, or recurrent angina pectoris, was higher in the DM group compared with the non-DM group (17.4 % vs 9.5 % , m>pm> = 0.007). Among diabetic patients, although SES reduced late loss by 0.45 mm (m>pm> < 0.001) and the binary restenosis rate by 66.4 % (7.4 % vs 22.0 % , m>pm> < 0.001) compared with PES at 8 months, it did not reduce target lesion revascularization or MACE, as in the non-DM group.

Conclusions

Diabetic patients have worse mid-term prognosis than non-diabetic patients undergoing PCI with DES. Although the superiority of SES in terms of late loss or restenosis may not play a clinically meaningful role in the treatment of diabetic patients, this phenomenon was independent of the presence of diabetes.