title: The influence of diabetes mellitus on acute and late clinical outcomes following coronary stent implantation.
abstract: OBJECTIVE
  We compared the clinical outcomes following coronary stent implantation in insulin-treated diabetes mellitus (IDDM), non-IDDM patients, and nondiabetic patients.
  
  
  BACKGROUND
  Diabetic patients have increased restenosis and late morbidity following balloon angioplasty. The impact of diabetes mellitus (DM), especially IDDM, on in-stent restenosis is not known.
  
  
  METHODS
  We studied 954 consecutive patients with native coronary artery lesions treated with elective Palmaz-Schatz stents implantation using conventional coronary angiographic and intravascular ultrasound methodology. Procedural success, major in-hospital complications, and 1-year clinical outcome were compared according to the diabetic status. RESULTS. In-hospital mortality was 2% in IDDM, significantly higher (p <0.02) compared with non-IDDM (0%) and nondiabetics (0.3%). Stent thrombosis did not differ among groups (0.9% in IDDM vs. 0% in non-IDDM and 0% in nondiabetics, p >0.1). During follow-up, target lesion revascularization (TLR) was 28% in IDDM, significantly higher (p <0.05) compared with non-IDDM (17.6%) and nondiabetics (16.3%). Late cardiac event-free survival (including death, myocardial infarction [MI], and any coronary revascularization procedure) was significantly lower (p=0.0004) in IDDM (60%) compared with non-IDDM (70%) and nondiabetic patients (76%). By multivariate analysis, IDDM was an independent predictor for any late cardiac event (OR=2.05, p=0.0002) in general and TLR (odds ratio=2.51, p=0.0001) in particular. CONCLUSIONS. In a large consecutive series of patients treated by elective stent implantation, IDDM patients were at higher risk for in-hospital mortality and subsequent TLR and, as a result, had a significantly lower cardiac event-free survival rate. On the other hand, acute and long-term procedural outcome was found to be similar for non-IDDM compared with nondiabetic patients.
authors.affiliation: Cardiac Catheterization Laboratories, The Washington Hospital Center, DC, USA.
authors.forename: A
authors.initials: A
authors.lastname: Abizaid
authors.forename: R
authors.initials: R
authors.lastname: Kornowski
authors.forename: G S
authors.initials: GS
authors.lastname: Mintz
authors.forename: M K
authors.initials: MK
authors.lastname: Hong
authors.forename: A S
authors.initials: AS
authors.lastname: Abizaid
authors.forename: R
authors.initials: R
authors.lastname: Mehran
authors.forename: A D
authors.initials: AD
authors.lastname: Pichard
authors.forename: K M
authors.initials: KM
authors.lastname: Kent
authors.forename: L F
authors.initials: LF
authors.lastname: Satler
authors.forename: H
authors.initials: H
authors.lastname: Wu
authors.forename: J J
authors.initials: JJ
authors.lastname: Popma
authors.forename: M B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003922:Diabetes Mellitus, Type 1 / Q000000981:diagnostic imaging / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional