title: Impact of drug-eluting stents among insulin-treated diabetic patients: a report from the National Heart, Lung, and Blood Institute Dynamic Registry.
abstract: OBJECTIVE
  This study sought to evaluate the safety and efficacy of drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients with insulin- and noninsulin-treated diabetes.
  
  
  BACKGROUND
  Diabetes is a powerful predictor of adverse events after percutaneous coronary interventions (PCI), and insulin-treated diabetic patients have worse outcomes. The DES are efficacious among patients with diabetes; however, their safety and efficacy, compared with BMS, among insulin-treated versus noninsulin-treated diabetic patients is not well established.
  
  
  METHODS
  Using the National Heart, Lung, and Blood Institute Dynamic Registry, we evaluated 1-year outcomes of insulin-treated (n = 817) and noninsulin-treated (n = 1,749) patients with diabetes who underwent PCI with DES versus BMS.
  
  
  RESULTS
  The use of DES, compared with BMS, was associated with a lower risk for repeat revascularization for both noninsulin-treated patients (adjusted hazard ratio [HR] = 0.59, 95% confidence interval [CI] 0.45 to 0.76) and insulin-treated subjects (adjusted HR = 0.63, 95% CI 0.44 to 0.90). With respect to safety in the overall diabetic population, DES use was associated with a reduction of death or myocardial infarction (adjusted HR = 0.75, 95% CI 0.58 to 0.96). However, this benefit was confined to the population of noninsulin-treated patients (adjusted HR = 0.57, 95% CI 0.41 to 0.81). Among insulin-treated patients, there was no difference in death or myocardial infarction risk between DES- and BMS-treated patients (adjusted HR = 0.95, 95% CI 0.65 to 1.39).
  
  
  CONCLUSIONS
  Drug-eluting stents are associated with lower risk for repeat revascularization compared with BMS in treating coronary artery disease among patients with either insulin- or noninsulin-treated diabetes. In addition, DES use is not associated with any significant increased safety risk compared with BMS. These findings suggest that DES should be the preferred strategy for diabetic patients.
authors.affiliation: Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. mulukutlasr@upmc.edu
authors.forename: Suresh R
authors.initials: SR
authors.lastname: Mulukutla
authors.forename: Helen A
authors.initials: HA
authors.lastname: Vlachos
authors.forename: Oscar C
authors.initials: OC
authors.lastname: Marroquin
authors.forename: Faith
authors.initials: F
authors.lastname: Selzer
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Holper
authors.forename: J Dawn
authors.initials: JD
authors.lastname: Abbott
authors.forename: Warren K
authors.initials: WK
authors.lastname: Laskey
authors.forename: David O
authors.initials: DO
authors.lastname: Williams
authors.forename: Conrad
authors.initials: C
authors.lastname: Smith
authors.forename: William D
authors.initials: WD
authors.lastname: Anderson
authors.forename: Joon S
authors.initials: JS
authors.lastname: Lee
authors.forename: Vankeepuram
authors.initials: V
authors.lastname: Srinivas
authors.forename: Sheryl F
authors.initials: SF
authors.lastname: Kelsey
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Kip
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D003324:Coronary Artery Disease / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D048909:Diabetes Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000401:mortality; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D054555:National Heart, Lung, and Blood Institute (U.S.); D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D008670:Metals