title: Impact of diabetes on long-term outcome after primary angioplasty: insights from the DESERT cooperation.
abstract: OBJECTIVE
  Diabetes has been shown to be associated with worse survival and repeat target vessel revascularization (TVR) after primary angioplasty. The aim of the current study was to evaluate the impact of diabetes on long-term outcome in patients undergoing primary angioplasty treated with bare metal stents (BMS) and drug-eluting stents (DES).
  
  
  METHODS
  Our population is represented by 6,298 ST-segment elevation myocardial infarction (STEMI) patients undergoing primary angioplasty included in the DESERT database from 11 randomized trials comparing DES with BMS.
  
  
  RESULTS
  Diabetes was observed in 972 patients (15.4%) who were older (P < 0.001), more likely to be female (P < 0.001), with higher prevalence of hypertension (P < 0.001), hypercholesterolemia (P < 0.001), and longer ischemia time (P < 0.001), and without any difference in angiographic and procedural characteristics. At long-term follow-up (1,201 ± 441 days), diabetes was associated with higher rates of death (19.1% vs. 7.4%; P < 0.0001), reinfarction (10.4% vs. 7.5%; P < 0.001), stent thrombosis (7.6% vs. 4.8%; P = 0.002) with similar temporal distribution--acute, subacute, late, and very late--between diabetic and control patients, and TVR (18.6% vs. 15.1%; P = 0.006). These results were confirmed in patients receiving BMS or DES, except for TVR, there being no difference observed between diabetic and nondiabetic patients treated with DES. The impact of diabetes on outcome was confirmed after correction for baseline confounding factors (mortality, P < 0.001; repeat myocardial infarction, P = 0.006; stent thrombosis, P = 0.007; TVR, P = 0.027).
  
  
  CONCLUSIONS
  This study shows that among STEMI patients undergoing primary angioplasty, diabetes is associated with worse long-term mortality, reinfarction, and stent thrombosis in patients receiving DES and BMS. DES implantation, however, does mitigate the known deleterious effect of diabetes on TVR after BMS.
authors.affiliation: Division of Cardiology, Ospedale Maggiore della Carità, Eastern Piedmont University, Novara, Italy. giuseppe.deluca@maggioreosp.novara.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Luca
authors.forename: Maurits T
authors.initials: MT
authors.lastname: Dirksen
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.forename: Martin
authors.initials: M
authors.lastname: Schalij
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.forename: Bas
authors.initials: B
authors.lastname: van der Hoeven
authors.forename: Marteen A
authors.initials: MA
authors.lastname: Vink
authors.forename: Christoph
authors.initials: C
authors.lastname: Kaiser
authors.forename: Carmine
authors.initials: C
authors.lastname: Musto
authors.forename: Tania
authors.initials: T
authors.lastname: Chechi
authors.forename: Gaia
authors.initials: G
authors.lastname: Spaziani
authors.forename: Luis Salvador
authors.initials: LS
authors.lastname: Diaz de la Llera
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pasceri
authors.forename: Emilio
authors.initials: E
authors.lastname: Di Lorenzo
authors.forename: Roberto
authors.initials: R
authors.lastname: Violini
authors.forename: Harry
authors.initials: H
authors.lastname: Suryapranata
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome