title: Prognostic influence of diabetes mellitus on long-term clinical outcomes and stent thrombosis after drug-eluting stent implantation in asian patients.
abstract: Diabetes mellitus has been associated with an increased risk of mortality and stent thrombosis after implantation of drug-eluting stents (DES). Little is known about the prognostic impact of diabetes on clinical outcomes in an Asian population treated with DES. We compared adverse outcomes between 865 patients with diabetes and 2,295 patients without diabetes treated with DES after adjustment for differences in baseline risk factors in the patients. The primary outcome was the composite of death, nonfatal myocardial infarction, or target-vessel revascularization (TVR). The 3-year unadjusted rates of death (5.8% vs 3.5%, p = 0.002) and TVR (12.2% vs 8.6%, p = 0.003) were significantly higher in patients with diabetes. After adjustment for baseline differences, the risk of TVR remained higher in patients with diabetes (hazard ratio 1.37, 95% confidence interval [CI] 1.04 to 1.81, p = 0.03), but the risk of death did not (hazard ratio 1.35, 95% CI 0.89 to 2.05, p = 0.16). The 3-year adjusted risk of the primary composite outcome was significantly higher in patients with diabetes compared with patients without diabetes (23.3% vs 16.1%, hazard ratio 1.24, 95% CI 1.02 to 1.51, p = 0.03). Insulin use was an independent predictor for each outcome (death, TVR, and composite outcome). After adjustment by baseline risk profile and for propensity, diabetes was not associated with an increased risk of stent thrombosis (multivariable-adjusted hazard ratio 0.87, 95% CI 0.36 to 2.15, p = 0.77 and propensity-adjusted hazard ratio 0.87, 95% CI 0.37 to 2.06, p = 0.76). In conclusion, diabetic status was associated with increased TVR without a significantly increased rate of death. A diabetes-associated excess risk of stent thrombosis was not observed in Asian patients.
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.forename: James D
authors.initials: JD
authors.lastname: Flaherty
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Davidson
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
authors.forename: Sang-Sig
authors.initials: SS
authors.lastname: Cheong
authors.forename: Jae-Joong
authors.initials: JJ
authors.lastname: Kim
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D044466:Asian People; D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy*; D048909:Diabetes Complications; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013927:Thrombosis / Q000209:etiology*