Long-term clinical benefit of drug-eluting stents over bare-metal stents in diabetic patients with de novo left main coronary artery disease: results from a real-world multicenter registry.
BACKGROUND
Few data are available on diabetic patients undergoing percutaneous coronary intervention (PCI) in the context of unprotected left main coronary artery (ULMCA) disease. The main goal of this study was to present the long-term relative benefits of using drug-eluting stent (DES) instead of bare-metal stent (BMS) for diabetic patients submitted to percutaneous ULMCA treatment in a large real world multicenter registry.


METHODS
The GISE-SICI registry is a retrospective, observational multicenter registry promoted by the Italian Society of Invasive Cardiology in which 19 high-volume participating centers enrolled 1,453 consecutive patients who underwent PCI on ULMCA between January 2002 and December 2006. From the registry, a total of 398 consecutive patients with diabetes mellitus who underwent DES (n = 321) or BMS (n = 77) implantation were analyzed, with extensive multivariable adjustments.


RESULTS
At 3-years, use of DES in diabetic patients resulted in no significant differences with respect to death (HR 0.56, 95% CIs 0.24-1.28), myocardial infarction (HR 0.82, 95% CIs 0.21-3.26), and the composite end-point of death or myocardial infarction (HR 0.56, 95% CIs 0.27-1.20). Conversely, DES were associated with significant reduction of target lesion revascularization (TLR, HR 0.33; 95% CIs 0.14-0.80, P = 0.001) rates.


CONCLUSIONS
Patients presenting with ULMCA disease in the context of diabetes mellitus who are treated with stent-supported PCI have a significant reduction in the rate of TLR with no increased risk of death or myocardial infarction.
Capodanno
Davide
D
Dipartimento di Cardiologia, Ospedale Ferrarotto, Università di Catania, Italy. dcapodanno@gmail.com
Di Salvo
Maria Elena
ME
Palmerini
Tullio
T
Sheiban
Imad
I
Margheri
Massimo
M
Vecchi
Giuseppe
G
Sangiorgi
Giuseppe
G
Piovaccari
Giancarlo
G
Bartorelli
Antonio
A
Briguori
Carlo
C
Ardissino
Diego
D
Di Pede
Francesco
F
Ramondo
Angelo
A
Inglese
Luigi
L
Petronio
Anna Sonia
AS
Bolognese
Leonardo
L
Benassi
Alberto
A
Palmieri
Cataldo
C
Filippone
Vincenzo
V
De Servi
Stefano
S
Tamburino
Corrado
C
D000368:Aged; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000628:therapy*; D003920:Diabetes Mellitus; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome