title: Sirolimus-eluting stent implantation in diabetic patients with multivessel coronary artery disease.
abstract: BACKGROUND
  Restenosis rate is lower after sirolimus-eluting stent (SES) implantation than after bare metal stent (BS) implantation. We evaluated the impact of SES implantation on immediate and 12-month outcome in diabetic patients with multivessel coronary artery disease (MVD).
  
  
  METHODS
  From April 2002 to September 2003, 100 consecutive diabetic patients with MVD without previous myocardial revascularization underwent successful elective percutaneous coronary intervention (PCI) with SES on native coronary arteries at our institutions. A group (n = 122) of consecutive diabetic patients with MVD treated with BS implantation (BS group) for de novo lesions was selected from our database and matched with the SES group. Major adverse cardiac events (MACEs) during hospital stay and at follow-up included nonfatal myocardial infarction, death, bypass surgery, and re-PCI.
  
  
  RESULTS
  At 12 +/- 4 months, MACEs occurred in 25% of patients in the SES group and in 44% of those in the BS group (P = .003, OR .72, 95% CI 0.57-0.91). Need for repeat intervention (re-PCI or bypass surgery) occurred in 17% of patients in the SES group and in 41% of those in the BS group (P < .001, OR .67, 95% CI 0.52-0.86). No significant difference in the rate of death and myocardial infarction was observed. In the SES group, the independent predictors of MACEs at follow-up were premature clopidogrel discontinuation (hazard ratio 20.62, 95% CI 1.60-264.97, P = .020) and chronic renal insufficiency (hazard ratio 4.73, 95% CI 1.99-11.25, P = .0004).
  
  
  CONCLUSIONS
  As compared with BS implantation, SES implantation favorably influences outcome in diabetic patients with MVD, mainly by reducing the need for new revascularization.
authors.affiliation: Laboratory of Interventional Cardiology, Clinica Mediterranea, Naples, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Briguori
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Flavio
authors.initials: F
authors.lastname: Airoldi
authors.forename: Amelia
authors.initials: A
authors.lastname: Focaccio
authors.forename: Ioannis
authors.initials: I
authors.lastname: Iakovou
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Iassen
authors.initials: I
authors.lastname: Michev
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Erminio
authors.initials: E
authors.lastname: Bonizzoni
authors.forename: Bruno
authors.initials: B
authors.lastname: Ricciardelli
authors.forename: Gerolama
authors.initials: G
authors.lastname: Condorelli
mesh_terms: D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000150:complications / Q000401:mortality / Q000628:therapy*; D004337:Drug Carriers; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D013997:Time Factors
chemical_list: D004337:Drug Carriers; D020123:Sirolimus