Acute and late clinical outcomes of coronary balloon angioplasty with or without stenting in diabetes--the fact in the "real world".
BACKGROUND
Diabetes mellitus (DM) is one of the major risk factors of coronary artery disease (CAD). Both short- and long-term prognoses of plain old balloon angioplasty (POBA) are poorer in CAD patients with DM than in those without. Recent evidence indicates that coronary stenting significantly improves clinical results of POBA in CAD patients. However, the benefit of coronary stenting remains controversial in DM patients. The purpose of this study was to evaluate the acute and late clinical outcomes of coronary stenting as compared with POBA in diabetic patients with CAD in the real setting of our daily practice.


METHODS
Between June 1997 and September 1998, more than 400 consecutive CAD patients receiving POBA with or without coronary stenting were evaluated. The patients were those who had definite clinical diagnosis of DM and received coronary intervention for the first time on their de novo, native lesion(s). Patients were divided into 2 groups according to POBA alone or balloon dilatation followed by coronary stenting. The immediate angiographic results and clinical outcomes, including major adverse cardiovascular events (MACE) as well as recurrent angina within 24 hours after the procedure (acute) and more than 6 months (late) after the procedure were evaluated in the both groups of patients.


RESULTS
A total of 124 DM patients, aged 68 +/- 8 years with 85% male and 60% multivessel disease, were studied. There was no difference in baseline demographic data between those patients receiving POBA alone (POBA, n = 79) and in combination with coronary stenting (stent, n = 45). The minimal luminal diameter of the target lesion immediately after balloon dilatation was smaller in the stent group than in POBA group (1.36 +/- 0.67 vs. 1.96 +/- 1.31 mm, p < 0.001). However, the final luminal gain was much larger (1.60 +/- 0.64 vs. 0.80 +/- 0.88 mm, p < 0.001) and the acute event-free survival rate was higher (97.7% vs. 82.9%, p = 0.019) in stent group than in POBA group. While the percutaneous revascularization rate tended to be less in patients with stent than with POBA (31.8% vs. 49.3%, p = 0.08), the total late MACE rate was similar between both groups (50% vs. 64.7%, p = NS). However, the late event-free survival rates were significantly higher in stenting patients than in those with POBA (34.9% vs. 16.4%, p = 0.037).


CONCLUSIONS
Diabetic patients with significant CAD were clinically found to be old and largely with multivessel disease for coronary intervention. The immediate angiographic results were better if treated with stenting than with POBA alone. Though the rate of late MACE was similarly high in both groups, coronary stenting rendered a better acute event-free survival rate and especially late event-free survival rate, suggesting its benefit for percutaneous coronary revascularization in diabetic patients.
Leu
Hsin-Bang
HB
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, and Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
Chiu
Ting-Yu
TY
Chen
Jaw-Wen
JW
Wu
Tao-Chang
TC
Ding
Phillip Yu-An
PY
Chang
Mau-Song
MS
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D003331:Coronary Vessels; D048909:Diabetes Complications; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D015607:Stents; D016896:Treatment Outcome