Comparison of outcomes using sirolimus-eluting stenting in diabetic versus nondiabetic patients with comparison of insulin versus non-insulin therapy in the diabetic patients.
The effect of insulin therapy on adverse cardiovascular outcomes in diabetic patients has been debated and a reduced benefit in clinical restenosis outcomes after sirolimus stenting has been reported among diabetic patients requiring insulin therapy. We analyzed 297 diabetic patients receiving sirolimus-eluting stents, including 115 (39%) on insulin therapy, and compared outcomes with 541 nondiabetic patients treated consecutively during the same interval. The rates of target lesion revascularization (9.5% vs 3.5%, p = 0.003) and cardiac death or myocardial infarction (MI, 7.1% vs 3.1%, p = 0.012) were significantly higher for diabetic patients. Insulin treatment was independently associated with increased risk for target lesion revascularization (odds ratio [OR] 2.48, 95% confidence interval [CI] 1.22 to 5.00) and cardiac death or MI (hazard ratio [HR] 2.85, 95% CI 1.41 to 5.77), whereas the adjusted risk for diabetic patients not treated with insulin was not significantly different from patients without diabetes for target lesion revascularization (OR 1.32, 95% CI 0.66 to 2.62) or cardiac death or MI (HR 1.04, 95% CI 0.50 to 2.17). In conclusion, diabetes mellitus is associated with increased risk for target lesion revascularization and cardiac death or MI after receiving sirolimus-eluting stenting, and is significantly exaggerated by the requirement for insulin therapy.
Kumar
Ramon
R
Department of Medicine, Cardiology Division, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Lee
Tobias T
TT
Jeremias
Allen
A
Ruisi
Christopher P
CP
Sylvia
Brett
B
Magallon
Jorge
J
Kirtane
Ajay J
AJ
Bigelow
Brian
B
Abrahamson
Martin
M
Pinto
Duane S
DS
Ho
Kalon K L
KK
Cohen
David J
DJ
Carrozza
Joseph P
JP
Cutlip
Donald E
DE
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D023921:Coronary Stenosis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy; D016503:Drug Delivery Systems; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents; D007328:Insulin; D020123:Sirolimus