Outcomes of diabetics receiving bare-metal stents versus drug-eluting stents.
OBJECTIVE
We sought to determine if differences existed in in-hospital outcomes, long-term rates of target vessel revascularization (TVR), and/or long-term mortality trends between patients with diabetes mellitus undergoing percutaneous coronary intervention (PCI) with either a drug-eluting stent(s) (DES) or a bare metal stent(s) (BMS).


BACKGROUND
Short- and long-term clinical outcomes of patients with diabetes mellitus undergoing PCI with DES versus BMS remain inconsistent between randomized-controlled trials (RCTs) and observational studies.


METHODS
Data were collected prospectively on diabetics undergoing PCI with either DES or BMS from January 2000 to June 2008. Demographic information, medical histories, in-hospital outcomes, and long-term TVR and mortality trends were obtained for all patients.


RESULTS
A total of 1,319 patients were included in the study. Diabetics receiving DES had a significant reduction in index admission MACE compared to diabetics receiving BMS. Using multivariable adjustment, after a mean follow-up of 2.5 years (maximum 5 years), diabetics who received DES had a 38% decreased risk of TVR compared to diabetics with BMS [HR 0.62 (95% CI: 0.43-0.90)]; diabetics with DES had an insignificant adjusted improvement in long-term survival compared to diabetics with BMS [HR 0.72 (95% CI: 0.52-1.00)]. These long-term survival and TVR rates were confirmed using propensity scoring.


CONCLUSIONS
The use of DES when compared with BMS among diabetics undergoing PCI is associated with significant improvement in long-term TVR, with an insignificant similar trend in all-cause mortality. The long-term results of this observational study are consistent with prior RCTs after adjusting for confounding variables.
Ramanath
Vijay S
VS
Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Dartmouth Medical School, Lebanon, New Hampshire.
Brown
Jeremiah R
JR
Malenka
David J
DJ
DeVries
James T
JT
Sidhu
Mandeep S
MS
Robb
John F
JF
Jayne
John E
JE
Hettleman
Bruce D
BD
Friedman
Bruce J
BJ
Niles
Nathaniel W
NW
Kaplan
Aaron V
AV
Thompson
Craig A
CA
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000401:mortality; D054855:Drug-Eluting Stents; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D009511:New England; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D008670:Metals