Diabetic retinopathy and coronary implantation of sirolimus-eluting stents.
BACKGROUND
The prognostic value of identifying the retinal status of diabetic patients undergoing coronary implantation of drug-eluting stents is unknown.


METHODS
We evaluated the outcomes of 318 consecutive patients undergoing implantation of sirolimus-eluting stents for coronary artery disease. Patients were divided into 5 groups according to the diabetic and retinal status: diabetic patients without retinopathy (43 patients); diabetic patients with nonproliferative retinopathy (34); diabetic patients with proliferative retinopathy (37); diabetic patients with unknown retinal status (30); and nondiabetic patients (174).


RESULTS
During a mean follow-up of 385 days, 64 patients had target-vessel failure (defined as a composite of death from cardiac causes, myocardial infarction, and target-vessel revascularization). At 1 year, Kaplan-Meier estimates of the rate of target-vessel failure were 15.3% for diabetic patients without retinopathy, 56.6% for those with nonproliferative retinopathy, 17.3% for those with proliferative retinopathy, 19.0% for those with unknown retinal status, and 16.0% for nondiabetic patients. After adjustment for the potential confounders and differences between groups, the relation of nonproliferative retinopathy to target-vessel failure remained significant. In an analysis in which diabetic patients without retinopathy were used as the reference group, the hazard ratios for target-vessel failure were 3.9 for those with nonproliferative retinopathy, 1.3 for those with proliferative retinopathy, 1.1 for those with unknown retinal status, and 1.4 for nondiabetic patients (P for trend = 0.015).


CONCLUSIONS
As compared with diabetic patients without retinopathy, those with nonproliferative retinopathy have an increased risk for target-vessel failure after coronary implantation of sirolimus-eluting stents.
Ohno
Takayuki
T
Department of Cardiothoracic Surgery, The University of Tokyo, Tokyo, Japan. takohnotky@umin.net
Takamoto
Shinichi
S
Ando
Jiro
J
Morita
Toshihiro
T
Fujita
Hideo
H
Hirata
Yasunobu
Y
Shigeeda
Takashi
T
Hirose
Akira
A
Nagai
Ryozo
R
D000368:Aged; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000601:surgery*; D003930:Diabetic Retinopathy / Q000150:complications / Q000175:diagnosis; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D020123:Sirolimus / Q000008:administration & dosage / Q000627:therapeutic use*; D015607:Stents; D017211:Treatment Failure; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D020123:Sirolimus