title: One-year clinical outcomes after sirolimus-eluting coronary stent implantation in diabetics enrolled in the worldwide e-SELECT registry.
abstract: BACKGROUND
  Diabetes mellitus has worse outcome after percutaneous coronary intervention.
  
  
  OBJECTIVE
  We assessed stent thrombosis (ST), major adverse cardiac events (MACE), and major bleeding rates at 1 year after implantation of sirolimus-eluting stents (SES) in patients with diabetes mellitus in a large multicenter registry.
  
  
  METHODS
  From May 2006 to April 2008, 15,147 unselected consecutive patients were enrolled at 320 centers in 56 countries in a prospective, observational registry after implantation of ≥ 1 SES. Source data were verified in 20% randomly chosen patients at > 100 sites. Adverse events were adjudicated by an independent Clinical Event Committee.
  
  
  RESULTS
  Complete follow-up at 1 year was obtained in 13,693 (92%) patients, 4,577 (30%) of whom were diabetics. Within diabetics, 1,238 (9%) were insulin-treated diabetics (ITD). Diabetics were older (64 vs. 62 years, P < 0.001), with higher incidence of major coronary risk factors, co-morbidities, and triple-vessel coronary artery disease. Coronary lesions had smaller reference vessel diameter (2.88 ± 0.46 vs. 2.93 ± 0.45 mm, P < 0.001) and were more often heavily calcified (26.1% vs. 22.6%, P < 0.001). At 1 year, diabetics had higher MACE rate (6.8% vs. 3.9%, P < 0.001) driven by ITD (10.6% vs. 5.5%, P < 0.001). Finally, diabetics had significant increase in ST (1.7% vs. 0.7%, P < 0.001), principally owing to ITD (3.4% vs. 1.1%, P < 0.001). There was an overall low risk of major bleeding during follow-up, without significant difference among subgroups.
  
  
  CONCLUSIONS
  In the e-SELECT registry, diabetics represented 30% of patients undergoing SES implantation and had significantly more co-morbidities and complex coronary lesions. Although 1-year follow-up documented good overall outcome in diabetics, higher ST and MACE rates were observed, mainly driven by ITD. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy.
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
authors.affiliation: Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Egidy Assenza
authors.affiliation: Instituto Dante Pazzanese De Cardiologia, Sao Paolo, Brazil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Abizaid
authors.affiliation: John Radcliffe Hospital, Oxford, United Kingdom.
authors.forename: Adrian
authors.initials: A
authors.lastname: Banning
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Stephen
authors.initials: S
authors.lastname: Ellis
authors.affiliation: Cardiovascular Institute and Fu Wai Hospital, Beijing, China.
authors.forename: Runlin
authors.initials: R
authors.lastname: Gao
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: David
authors.initials: D
authors.lastname: Holmes
authors.affiliation: The Heart Center of Chonnam National University Hospital, Gwang Ju, Korea.
authors.forename: Myung
authors.initials: M
authors.lastname: Ho Jeong
authors.affiliation: Centre Hospitalier Universitaire, Liège, Belgium.
authors.forename: Victor
authors.initials: V
authors.lastname: Legrand
authors.affiliation: Universitäts-Herzzentrum Freiburg, Bad Krozingen, Germany.
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.affiliation: Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris Descartes University and INSERM, U 970, Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.affiliation: Cardiovascular Investigation Unit Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Worthley
authors.affiliation: La Tour Hospital, Geneva, Switzerland.
authors.forename: Philip
authors.initials: P
authors.lastname: Urban
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003920:Diabetes Mellitus; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D020123:Sirolimus / Q000494:pharmacology*; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus
keywords: antithrombotic therapy; bleeding complications; diabetes mellitus; percutaneous coronary intervention; sirolimus-eluting stent; stent thrombosis