title: Diabetes mellitus and the clinical and angiographic outcome after coronary stent placement.
abstract: OBJECTIVE
  The objectives of this study were to analyze the clinical and angiographic outcome of diabetic patients with successful coronary stent placement and to compare these results with those achieved after stenting in nondiabetic patients.
  
  
  BACKGROUND
  The outcome of diabetic patients treated with stent placement due to coronary artery disease has not been assessed comprehensively.
  
  
  METHODS
  This study analyzes a consecutive series of patients with successful stent placement comprising 715 patients with diabetes and 2,839 patients without diabetes. Clinical one year follow-up and angiographic control at 6 months were part of the protocol. Death, myocardial infarction and target lesion revascularization were considered as adverse events. An automated edge detection system was used for the angiographic assessment. The primary clinical endpoint was event-free survival at one year. The primary angiographic endpoint was restenosis rate at 6 months (> or = 50% diameter stenosis).
  
  
  RESULTS
  Event-free survival was significantly lower in diabetic than in nondiabetic patients (73.1 vs. 78.5%, p < 0.001). Survival free of myocardial infarction was also significantly reduced in the diabetic group (89.9 vs. 94.4% in nondiabetics, p < 0.001). The incidence of both restenosis (37.5 vs. 28.3%, p < 0.001) and stent vessel occlusion (5.3 vs. 3.4%, p = 0.037) was significantly higher in diabetic patients. Diabetes was identified as an independent risk factor for adverse clinical events and restenosis in multivariate analyses.
  
  
  CONCLUSIONS
  Patients with diabetes mellitus have a less favorable clinical outcome at one year after successful stent placement as compared to the nondiabetic patients. The clinical follow-up was characterized by a higher incidence of death, myocardial infarction and reinterventions. Diabetic patients also demonstrated an increased risk for restenosis.
authors.affiliation: Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Elezi
authors.forename: A
authors.initials: A
authors.lastname: Kastrati
authors.forename: J
authors.initials: J
authors.lastname: Pache
authors.forename: A
authors.initials: A
authors.lastname: Wehinger
authors.forename: M
authors.initials: M
authors.lastname: Hadamitzky
authors.forename: J
authors.initials: J
authors.lastname: Dirschinger
authors.forename: F J
authors.initials: FJ
authors.lastname: Neumann
authors.forename: A
authors.initials: A
authors.lastname: Schömig
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications* / Q000628:therapy*; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012044:Regression Analysis; D015607:Stents; D016896:Treatment Outcome