Long-term clinical and angiographic outcomes of diabetic patients after revascularization with early generation drug-eluting stents

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• 作者：Michael Billinger ; MD^a ; ^f ; Lorenz Rä ; ber ; MD^a ; ^f ; Sarah Hitz ; MS^a ; Giulio G. Stefanini ; MD^a ; Thomas Pilgrim ; MD^a ; Christoph Stettler ; MD^b ; Thomas Zanchin ; MS^a ; Cedric Pulver ; MS^a ; Nico Pfä ; ffli ; MS^a ; Franz Eberli ; MD^c ; Bernhard Meier ; MD^a ; Bindu Kalesan ; MSc^d ; ^e ; Peter Jü ; ni ; MD^d ; ^e ; Stephan Windecker ; MD^a ; ^e ; ^{stephan.windecker@insel.ch}
• 刊名：American Heart Journal
• 出版年：2012
• 期刊代码：7_00028703
• 类别：med
• 出版时间：May, 2012
• 卷：163
• 期：5
• 页码：876-886.e2
• 文件大小：490 K

摘要

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Background

Early generation drug-eluting stents (DESs) reduce restenosis and repeat revascularization procedures. However, the long-term safety and efficacy of early generation DES according to diabetic status are poorly established.

Methods

A total of 1,012 patients were randomly assigned to treatment with sirolimus-eluting (n = 503) or paclitaxel-eluting stents (n = 509). Serial angiographic follow-up at baseline, 8 months, and 5 years was available in 293 patients with 382 lesions. The primary end point was a composite of major adverse cardiac events (cardiac death, myocardial infarction, and ischemia-driven target lesion revascularization). Clinical and angiographic outcomes through 5-year follow-up were compared between diabetic and nondiabetic patients.

Results

Major adverse cardiac events were more common among diabetic than nondiabetic patients at 5 years (25.9%vs 19.2%, hazard ratio [HR] 1.45, 95%CI 1.06-1.99, P = .02). The difference in disfavor of diabetic patients was largely determined by a higher rate of cardiac mortality (11.4%vs 4.3%, HR 2.86, 95%CI 1.69-4.84, P < .0001), whereas the risk of myocardial infarction (6.5%vs 6.8%, HR 1.00, 95%CI 0.55-1.84, P = .99) and ischemia-driven target lesion revascularization (14.4%vs 14.1%, HR 1.09, 95%CI 0.73-1.64, P = .67) was comparable. The risk of stent thrombosis was similar among diabetic and nondiabetic patients (definite or probable: 6.0%vs 4.6%, HR 1.36, 95%CI 0.71-2.67, P = .35). Among 293 patients undergoing serial angiography, very-late lumen loss amounted to 0.42 卤 0.63 mm in diabetic patients and 0.44 卤 0.68 mm in nondiabetic patients (P = .79).

Conclusions

Diabetic patients remain at increased risk for mortality after revascularization with early generation DES during long-term follow-up. Conversely, diabetes is no longer associated with an increased risk of clinical and angiographic restenosis after revascularization with early generation DES.