title: Long-term outcome of early percutaneous coronary intervention in diabetic patients with acute coronary syndrome: insights from the BASE ACS trial.
abstract: The BASE ACS trial demonstrated an outcome of titanium-nitride-oxide-coated bioactive stents (BAS) that was non-inferior to everolimus-eluting stents (EES) in patients with acute coronary syndrome (ACS). We performed a post-hoc analysis of diabetic versus non-diabetic patients from the trial.
  
  
  
  We randomised 827 patients (1:1) with ACS to receive either BAS or EES. The primary endpoint was major adverse cardiac events (MACE): a composite of cardiac death, non-fatal myocardial infarction (MI) or ischaemia-driven target lesion revascularisation (TLR). Follow-up was planned yearly through 7 years.
  
  
  
  Of 827 patients, 140 (16.9%) were diabetic; of these, 36 (25.7%) were insulin-treated. Mean follow-up duration was 4.2 ± 1.9 years. MACE was more frequent in diabetics versus non-diabetics (23.6% versus 13.7%, respectively, p = 0.003), mainly driven by more frequent cardiac death (7.9% versus 2.2%, respectively, p = 0.002). The rates of non-fatal MI, ischaemia-driven TLR were comparable (p > 0.05 for all). In diabetic patients, MACE was comparable between the two stent arms (18.5% versus 28.0%, for BAS versus EES, respectively, p = 0.18).
  
  
  
  Diabetic patients treated with early percutaneous coronary intervention for ACS had worse long-term outcome, compared with non-diabetics, mainly driven by more frequent cardiac death. The long-term outcome of BAS was comparable to EES in diabetics. Key Messages Diabetic patients presenting with acute coronary syndrome who were treated with early percutaneous coronary intervention had worse long-term clinical outcome, compared with non-diabetics, mainly driven by a high incidence of cardiac death. Age independently predicted both major adverse cardiac events and cardiac death in diabetic patients. The long-term clinical outcome of titanium-nitride-oxide-coated bioactive stents was comparable to that of everolimus-eluting stents in the diabetic, as well as in the non-diabetic subgroup.
authors.affiliation: a Heart Center, Satakunta Central Hospital , Pori , Finland ;
authors.forename: Pasi P
authors.initials: PP
authors.lastname: Karjalainen
authors.affiliation: b Heart Center, Turku University Hospital , Turku , Finland ;
authors.forename: Juhani K E
authors.initials: JK
authors.lastname: Airaksinen
authors.affiliation: c Department of Cardiology , Brighton and Sussex University Hospital NHS Trust , Brighton , UK ;
authors.forename: Adam
authors.initials: A
authors.lastname: de Belder
authors.affiliation: d Medical Research Center, Oulu University Hospital, and University of Oulu , Oulu , Finland ;
authors.forename: Hannu
authors.initials: H
authors.lastname: Romppanen
authors.affiliation: d Medical Research Center, Oulu University Hospital, and University of Oulu , Oulu , Finland ;
authors.forename: Kari
authors.initials: K
authors.lastname: Kervinen
authors.affiliation: e Department of Cardiology , Kokkola Central Hospital , Kokkola , Finland ;
authors.forename: Jussi
authors.initials: J
authors.lastname: Sia
authors.affiliation: f Helsinki University Hospital , Helsinki , Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Laine
authors.affiliation: a Heart Center, Satakunta Central Hospital , Pori , Finland ;
authors.forename: Wail
authors.initials: W
authors.lastname: Nammas
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000368:Aged; D048909:Diabetes Complications / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000706:statistics & numerical data; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D016019:Survival Analysis; D014025:Titanium / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: C434243:titanium-nitride-oxide; D000068338:Everolimus; D014025:Titanium
keywords: Acute coronary syndrome; diabetes mellitus; everolimus-eluting stents; titanium-nitride-oxide-coated stents