Safety and effectiveness of drug-eluting stents among diabetic patients: a propensity analysis.
BACKGROUND
Diabetic patients frequently receive drug-eluting stents (DES) during percutaneous coronary interventions (PCI), but recent data have raised concerns as to whether DES are associated with increased risk of myocardial infarction or death. Accordingly, we sought to evaluate the long-term safety and effectiveness of DES in diabetic patients.


METHODS
We used a propensity score matching method to create and analyze a well-balanced cohort that included 2,374 diabetic patients who received PCI in Ontario, Canada, from December 1, 2003, to March 31, 2005. Primary outcomes of interest were repeat target-vessel revascularization, myocardial infarction, and death after the index PCI.


RESULTS
The mean age of our diabetic cohort was 64 years, and 68% of the patents were male. At 2 years, rates of repeat target-vessel revascularization were significantly lower among diabetic patients treated with DES compared with those treated with bare metal stents (BMS) (7.1% vs 14.4%, P < .001). Myocardial infarction rates were not significantly different between the 2 groups after 2 years (6.6% in DES group vs 4.5% in BMS group, P = .45). In addition, mortality was not statistically different among diabetic patients treated with DES (7.6%) and BMS (9.5%) (P = .086).


CONCLUSIONS
Drug-eluting stents are effective among diabetic patients in substantially reducing the need for repeat target-vessel revascularization. The overall rates of myocardial infarction were not significantly different between DES and BMS. In addition, the mortality of diabetic patients who received DES was not significantly increased compared with BMS.
Ko
Dennis T
DT
Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. dennis.ko@ices.on.ca
Chiu
Maria
M
Austin
Peter C
PC
Bowen
James
J
Cohen
Eric A
EA
Tu
Jack V
JV
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D016022:Case-Control Studies; D015331:Cohort Studies; D003327:Coronary Disease / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D023903:Coronary Restenosis / Q000175:diagnosis / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000150:complications* / Q000175:diagnosis; D054855:Drug-Eluting Stents; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome