title: High-risk diabetic patients with unprotected left main coronary artery disease: characteristics and medium-term outcomes of percutaneous revascularization with drug-eluting stents.
abstract: Percutaneous coronary intervention with drug-eluting stents is an alternative for patients with high-risk unprotected left main coronary artery disease; those with diabetes mellitus are at even higher risk. Recent advances in percutaneous coronary intervention could lead to better results. The aim of this study was to evaluate medium-term results in a real-world sample of high-risk diabetic patients undergoing percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease.From 3 tertiary hospitals, we retrospectively identified 334 high-risk patients, of whom 141 (42%) were diabetic and 193 (58%) were nondiabetic. The diabetes mellitus group showed a higher prevalence of peripheral vascular disease and left ventricular dysfunction. Angiographic and procedural characteristics did not differ significantly, with the exception of poor distal vessels in the diabetes mellitus group (44.5% vs 28.5%, P = 0.006). The use of intra-aortic balloon pumping and intravascular ultrasonography was low in both diabetic and nondiabetic patients. After a median follow-up of 22.4 months, cardiac death was higher in the diabetes mellitus group (16.2% vs 7.5%, P = 0.015), especially in insulin-dependent diabetic patients (25.8%). The incidence of major adverse cardiac events, including cardiac death, target-lesion revascularization, and myocardial infarction was similar in both groups (23.8% vs 18.3%, P = NS).High-risk diabetic patients who undergo percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease present with a worse clinical profile that carries a higher cardiac mortality rate in the medium term, especially in insulin-dependent diabetic patients.
authors.affiliation: Cardiac Catheterization & Interventional Cardiology Units, Juan Ramón Jiménez Hospital, Spain.
authors.forename: Jose F Díaz
authors.initials: JF
authors.lastname: Fernández
authors.forename: Carlos Sánchez
authors.initials: CS
authors.lastname: González
authors.forename: Manuel Jiménez
authors.initials: MJ
authors.lastname: Navarro
authors.forename: Juan C
authors.initials: JC
authors.lastname: Fernández Guerrero
authors.forename: Antonio Gómez
authors.initials: AG
authors.lastname: Menchero
authors.forename: Juan H Alonso
authors.initials: JH
authors.lastname: Briales
authors.forename: Rosa María Cardenal
authors.initials: RM
authors.lastname: Piris
authors.forename: Juan
authors.initials: J
authors.lastname: Herrador
authors.forename: Manuel Guzmán
authors.initials: MG
authors.lastname: Herrera
authors.forename: Jose M Hernández
authors.initials: JM
authors.lastname: García
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000209:etiology; D016009:Chi-Square Distribution; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000401:mortality; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome