title: Impact of diabetes on five-year outcomes after vein graft interventions performed prior to the drug-eluting stent era.
abstract: OBJECTIVE
  The aim of this study was to evaluate the differences in 5-year outcomes among diabetic and nondiabetic patients undergoing saphenous vein graft (SVG) percutaneous coronary intervention (PCI) prior to the era of distal protection and drug-eluting stents.
  
  
  BACKGROUND
  PCI of native coronary arteries is known to be associated with higher rates of adverse outcomes in diabetic patients compared to nondiabetic patients. However, the impact of diabetes on long-term outcomes after SVG interventions is not as well established. We conducted an evaluation of 5-year outcomes after SVG PCI in the two decades prior to the availability of distal protection devices and drug-eluting stents.
  
  
  METHODS
  Data on 2,556 subjects (1,780 nondiabetic and 776 diabetic) undergoing SVG PCI at Emory Hospital from 1981 to 2001 were collected and entered into a computerized database and analyzed for adverse cardiovascular outcomes.
  
  
  RESULTS
  Compared to the nondiabetic group, the diabetic group had worse 1-year (87.7% vs. 94.9%; p < 0.0001) and 5-year survival rates (62.9% vs. 78.5%; p < 0.0001). In the subset of patients receiving stents, 5-year survival remained significantly worse in the diabetic group (78.2% vs. 87.1%; p = 0.009). After multivariate analysis, diabetes was an independent predictor of 5-year mortality (hazard ratio = 1.8; 95% CI = 1.5-2.5; p < 0.0001).
  
  
  CONCLUSIONS
  Diabetic patients undergoing vein graft PCI prior to the distal protection and drug-eluting stent era had significantly worse long-term outcomes compared to nondiabetic patients. The effect on long-term outcomes using these newer devices in diabetic subjects undergoing SVG PCI must be established for a true assessment of their impact.
authors.affiliation: University of Kansas School of Medicine-Wichita, Wichita, Kansas, USA.
authors.forename: Salman
authors.initials: S
authors.lastname: Ashfaq
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Ghazzal
authors.forename: John S
authors.initials: JS
authors.lastname: Douglas
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Morris
authors.forename: Emir
authors.initials: E
authors.lastname: Veledar
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D002309:Cardiology / Q000639:trends*; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011379:Prognosis; D019233:Retreatment; D012501:Saphenous Vein / Q000637:transplantation*; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome