title: Long-term results after drug-eluting stent implantation in diabetic patients according to diabetic treatment.
abstract: BACKGROUND
  In this prospective, single-center study we assessed the long-term results after drug-eluting stent implantation in non insulin-dependent diabetic patients compared to insulin-dependent patients.
  
  
  METHODS
  A total of 610 consecutive diabetic patients (mean age 65 ± 9 years) underwent percutaneous coronary intervention with drug-eluting stent implantation. They were classified into 2 groups according to their diabetic treatment: 1) non insulin-dependent patients (477); 2) insulin-dependent patients (133). The primary endpoint was the composite of death, non-fatal myocardial infarction, bypass surgery and target lesion revascularization.
  
  
  RESULTS
  Clinical follow up for more than 12 months (median 29 months) was achieved in 597/610 patients (98%). The insulin-dependent group had more women (29% vs. 18%, p=0.003), as well as a higher incidence of multivessel disease (84% vs. 65%, p<0.0001) and ejection fraction <40% (16% vs. 9%, p=0.037) compared to the non insulin-dependent group. The in-hospital results were almost the same in both groups, except for the incidence of non-Q myocardial infarction and bleeding complications, which were more frequent in the insulin-dependent group (9.8% vs. 4.8%, p=0.03, and 1.5% vs. 0%, p=0.047, respectively). During clinical follow up, no significant differences in the incidence of death or non-fatal myocardial infarction were observed, but target lesion revascularization and bypass surgery were more frequent in the insulin-dependent group (8.5% vs. 3.4%, p=0.01, and 4.7% vs. 1.3%, p=0.01, respectively). The event-free survival was lower in the insulin-dependent group (hazard ratio: 0.52; 95% confidence interval, 0.31-0.85, p=0.01).
  
  
  CONCLUSIONS
  The implantation of drug-eluting stents in diabetics is associated with excellent in-hospital and long-term results. However, the long-term effectiveness in insulin-dependent patients is lower, because of the greater risk of new revascularization.
authors.affiliation: Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece. vvoudris@otenet.gr
authors.forename: Vassilis
authors.initials: V
authors.lastname: Voudris
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Karyofillis
authors.forename: Sofia
authors.initials: S
authors.lastname: Thomopoulou
authors.forename: Constantinos
authors.initials: C
authors.lastname: Doulaptsis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Manginas
authors.forename: Gregory
authors.initials: G
authors.lastname: Pavlides
authors.forename: Dennis V
authors.initials: DV
authors.lastname: Cokkinos
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000453:epidemiology / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D011446:Prospective Studies; D016896:Treatment Outcome