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).
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.
Meliga
Emanuele
E
Department of Interventional Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands.
Garcia-Garcia
Hector M
HM
Valgimigli
Marco
M
Chieffo
Alaide
A
Biondi-Zoccai
Giuseppe
G
Maree
Andrew O
AO
Gonzalo
Nieves
N
Cook
Stephane
S
Cruz-Gonzalez
Ignacio
I
Marra
Sebastiano
S
De Servi
Stefano
S
Palacios
Igor F
IF
Windecker
Stephan
S
van Domburg
Ron
R
Colombo
Antonio
A
Sheiban
Imad
I
Serruys
Patrick W
PW
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