title: The impact of diabetes mellitus on long-term clinical outcomes after percutaneous coronary saphenous vein graft interventions in the drug-eluting stent era.
abstract: OBJECTIVE
  We aimed to compare early and late clinical outcomes in diabetic and nondiabetic patients who underwent saphenous vein graft (SVG) percutaneous coronary interventions (PCI) with the use of drug-eluting stents (DES).
  
  
  BACKGROUND
  Patients with diabetes mellitus are shown to have less favorable outcomes after SVG intervention with the use of bare metal stents. In the DES era, the impact of diabetes mellitus on restenosis and clinical outcomes post-SVG intervention is not clearly defined.
  
  
  METHODS
  From our institutional PCI registry database, we retrospectively analyzed 477 consecutive patients with prior coronary artery bypass graft surgery undergoing SVG PCI with the implantation of DES stratified by the presence or absence of diabetes mellitus. The primary end-point was 1-year major adverse cardiac event (MACE) rate, defined as death, Q wave myocardial infarction, and target lesion revascularization.
  
  
  RESULTS
  Baseline clinical characteristics, including mean graft age (120 ± 77 vs. 131 ± 86 months, P = 0.14), were similar between groups, save for a higher prevalence of systemic hypertension and chronic renal insufficiency, and higher body mass index in the diabetic group. Among the 604 SVG lesions treated with DES, the angiographic and procedural characteristics were well matched between groups except for the higher rate of distal protection device use (32% vs. 29%, P = 0.007) in the diabetic group. The rates of 1-year MACE (21% vs. 15%, P = 0.12) and all-cause mortality (7.6% vs. 6.7%, P = 0.86) were similar between groups. After adjustment for the relevant clinical co-variables, diabetic status was not associated with the composite end-point.
  
  
  CONCLUSIONS
  In conclusion, DES, when used for the treatment of vein graft lesions, equate the short- and long-term outcomes between diabetic and nondiabetic patients, suggesting that DES should be considered the default stent in diabetic populations undergoing PCI for the treatment of SVG lesions.
authors: Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors: Lakshmana K
authors: LK
authors: Pendyala
authors: Joshua P
authors: JP
authors: Loh
authors: Hironori
authors: H
authors: Kitabata
authors: Sa'ar
authors: S
authors: Minha
authors: Rebecca
authors: R
authors: Torguson
authors: Fang
authors: F
authors: Chen
authors: Lowell F
authors: LF
authors: Satler
authors: William O
authors: WO
authors: Suddath
authors: Augusto D
authors: AD
authors: Pichard
authors: Ron
authors: R
authors: Waksman
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004219:District of Columbia / Q000453:epidemiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D063868:Patient Outcome Assessment; D062645:Percutaneous Coronary Intervention; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000401:mortality; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*