Clinical outcome of patients with diabetes mellitus and chronic total occlusion treated with drug-eluting stents.
OBJECTIVE
The prognosis of patients with chronic total occlusion (CTO) and diabetes mellitus treated with percutaneous coronary intervention (PCI) and drug-eluting stent (DES) implantation is unknown.


METHODS
We compared the 12-month outcomes of 52 diabetic patients with CTO after successful PCI who underwent DES implantation with that of 47 patients with diabetes and CTO previously treated with bare-metal stents (BMS). Death, myocardial infarction and repeat PCI or coronary artery bypass surgery were considered as a combined primary endpoint.


RESULTS
At 1-year follow up, the primary endpoint occurred in 6% (n = 3) of patients treated with DES and 23% (n = 11) of the patients treated with BMS (p = 0.01). One patient in the DES group and 3 patients in the BMS group died during follow up (p = 0.26). Stepwise logistic regression analysis identified DES (odds ratio [OR] = 12.9, 95% confidence interval [CI] 2.90-57.5; p = 0.0004) and final minimal lumen diameter (odds ratio [OR] = 10.1, 95% CI 1.81-56.4; p = 0.01) as independent correlates of major adverse cardiac events (MACE) at follow up.


CONCLUSIONS
In patients with chronic total occlusion, DES were superior to bare-metal stents in reducing the MACE and should be considered a preferred treatment strategy for patients with diabetes and CTO undergoing PCI.
De Felice
Francesco
F
UO Cardiologia Interventistica Ospedale S Camillo, Rome, Italy. f.defelice@lycos.com
Fiorilli
Rosario
R
Parma
Antonio
A
Nazzaro
Marco Stefano
MS
Dibra
Alban
A
Musto
Carmine
C
De Santis
Antonella
A
Violini
Roberto
R
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D011379:Prognosis; D015607:Stents; D016896:Treatment Outcome
D008670:Metals