Effects of coronary stenting on vessel patency and long-term clinical outcome after percutaneous coronary revascularization in diabetic patients.
OBJECTIVE
We sought to compare coronary stent implantation with balloon angioplasty (BA), in a diabetic population, in terms of the six-month angiographic outcome and four-year clinical events.


BACKGROUND
Diabetic patients have a poor angiographic and clinical outcome after standard coronary BA. To date, it is still unclear whether stent implantation may improve this outcome.


METHODS
We investigated this issue by individual matching of 314 diabetic patients treated with either coronary stenting or standard BA. These two groups were derived from a population of consecutive diabetic patients (1993 to 1996). Matching criteria were gender, anti-diabetic regimen, stenosis location, reference diameter, and minimal luminal diameter (+/-0.4 mm). One lesion per patient was considered for matching.


RESULTS
Baseline characteristics were similar between the two groups of 157 patients. At six months, the rates of restenosis (27% vs. 62%; p < 0.0001) and occlusion (4% vs. 13%; p < 0.005) were lower in the stent group than in the BA group. This was associated with a significant decrease in ejection fraction at six months in the BA group (p = 0.02) while, during the same period, no change was observed in the stent group (p = NS). Subgroup analysis demonstrated that angiographic benefit was consistent among the subgroups. At four years, the combined clinical end point of cardiac death and non-fatal myocardial infarction was lower in the stent group (14.8% vs. 26.0%; p = 0.02), as was the need for repeat revascularization (35.4% vs. 52.1%; p = 0.001).


CONCLUSIONS
In a population of diabetic patients, coronary stent implantation was associated with a highly beneficial effect on the six-month angiographic outcome and four-year clinical events compared with standard BA.
Van Belle
Eric
E
Hôpital Cardiologique, Centre Hospitalier Régional and University of Lille, France. ericvanbelle@aol.com
Périé
Marc
M
Braune
David
D
Chmaït
Akram
A
Meurice
Thibaud
T
Abolmaali
Kaveh
K
McFadden
Eugène P
EP
Bauters
Christophe
C
Lablanche
Jean-Marc
JM
Bertrand
Michel E
ME
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D003331:Coronary Vessels / Q000503:physiopathology / Q000601:surgery*; D003920:Diabetes Mellitus / Q000401:mortality / Q000628:therapy*; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015607:Stents; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013995:Time; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*