title: Diabetic patients treated for unprotected left main coronary artery disease with drug eluting stents: a 3-year clinical outcome study. The diabetes and drug eluting stent for LeFT main registry (D-DELFT).
abstract: OBJECTIVE
  Diabetes mellitus (DM) plays an important role in the development of coronary artery disease. Although previous studies have associated drug-eluting stent (DES) implantation in diabetic patients with favourable clinical and angiographic outcomes, the very long-term efficacy of these devices in diabetic patients undergoing PCI for significant unprotected left main coronary artery (ULMCA) disease has not been established yet.
  
  
  RESULTS
  Consecutive diabetic patients (n=100), who underwent elective PCI with DES for de novo lesions in an ULMCA between April 2002 and April 2004 in seven tertiary health care centres, were identified retrospectively and analysed. Consecutive non-diabetic patients (n=193), who underwent elective DES implantation for unprotected ULMCA disease, were selected as a control group. All patients were followed for at least 36 months. At 3-years follow-up, freedom from cardiac death & myocardial infarction (CDMI), target lesion revascularisation (TLR) and target vessel revascularisation (TVR) did not differ significantly between groups. The adjusted freedom from major adverse cardiac events (MACE, defined as the occurrence of CD, MI or TVR) was 63.4% in the DM group and 77.6% in the controls (p<0.001). When divided into IDDM and NIDDM sub-groups, insulin-dependent DM (IDDM) but not non IDDM (NIDDM) patients had significantly lower freedom from CDMI, TLR, TVR and MACE compared to controls.
  
  
  CONCLUSIONS
  These results suggest that major improvements in DES technology and pharmacotherapy are still required to improve clinical outcome and that the decision to perform percutaneous revascularisation in this subset of patients should be taken cautiously and on a case by case basis.
authors.affiliation: Department of Interventional Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Meliga
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia-Garcia
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Maree
authors.forename: Nieves
authors.initials: N
authors.lastname: Gonzalo
authors.forename: Stephane
authors.initials: S
authors.lastname: Cook
authors.forename: Ignacio
authors.initials: I
authors.lastname: Cruz-Gonzalez
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Marra
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.forename: Igor F
authors.initials: IF
authors.lastname: Palacios
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Ron
authors.initials: R
authors.lastname: van Domburg
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000706:statistics & numerical data; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome