Diabetes mellitus and unstable coronary artery disease: improved clinical outcome of coronary artery stenting in an era of glycoprotein IIb/IIIa inhibitors and lipid-lowering therapy.
OBJECTIVE
The short- and long-term clinical outcomes of coronary artery stenting in diabetic patients with unstable coronary artery disease were assessed and compared with a cohort of non-diabetic patients in the context of platelet glycoprotein IIb/IIIa inhibitors and lipid-lowering therapy.


METHODS
The study population comprised 252 consecutive patients with unstable angina who underwent coronary artery stenting; of these 46 were diabetic and 206 were non-diabetic. In-hospital results and clinical outcome during follow-up (24 +/- 13 months, range 7-56 months) were obtained in all patients without major in-hospital complications. Survival curves and multivariate models for any late clinical event were reported.


RESULTS
A high clinical success rate and no difference in in-hospital complications between the two groups of patients were observed. Complete revascularization rate was similar in diabetic and non-diabetic patients (48% compared with 52%). A greater proportion of diabetic than non-diabetic patients received IIb/IIIa inhibitors during the procedure and lipid-lowering drugs at hospital discharge (87% compared with 46%, P=0.001 and 83% compared with 61%, P=0.006 respectively). At 2-year clinical follow-up, the incidences of death and myocardial infarction were similar in both groups; the need for any revascularization was only slightly higher in diabetic patients (P=NS). Incomplete revascularization and multi-vessel disease were independent predictors of any revascularization.


CONCLUSIONS
Coronary artery stenting combined with glycoprotein IIb/IIIa inhibitor infusion and long-term lipid-lowering therapy is an effective therapeutic strategy in diabetic patients with unstable coronary artery disease and is associated with good short- and long-term results, comparable to those observed in non-diabetic patients.
Voudris
Vassilis A
VA
First Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece. vvoudris@otenet.gr
Skoularigis
John S
JS
Dimitriou
Yvonne K
YK
Grapsa
Georgia N
GN
Malakos
John S
JS
Pavlides
Gregory S
GS
Manginas
Athanasios N
AN
Cokkinos
Dennis V
DV
D000368:Aged; D000789:Angina, Unstable / Q000150:complications / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D002995:Clofibric Acid; D003131:Combined Modality Therapy; D048909:Diabetes Complications / Q000628:therapy*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D019919:Prosthesis Implantation / Q000379:methods; D015607:Stents; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D002995:Clofibric Acid