Sirolimus-eluting stent implantation in diabetic patients with multivessel coronary artery disease.
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.
Briguori
Carlo
C
Laboratory of Interventional Cardiology, Clinica Mediterranea, Naples, Italy.
Colombo
Antonio
A
Airoldi
Flavio
F
Focaccio
Amelia
A
Iakovou
Ioannis
I
Chieffo
Alaide
A
Michev
Iassen
I
Montorfano
Matteo
M
Bonizzoni
Erminio
E
Ricciardelli
Bruno
B
Condorelli
Gerolama
G
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
D004337:Drug Carriers; D020123:Sirolimus