First and second generation DESs reduce diabetes adverse effect on mortality and re-intervention in multivessel coronary disease: 9-Year analysis.
OBJECTIVE
Diabetes portends an increased risk of adverse early and late outcomes in patients undergoing PCI. In this study, we aimed to investigate if the adverse effect of diabetes mellitus (DM) on early and late PCI outcomes is reduced with drug-eluting (DES) compared to bare-metal (BMS) stents.


METHODS
We reviewed the Mount Sinai Beth Israel Hospital first PCI experience for multivessel coronary artery disease (CAD, 1998-2009). Patients were excluded if they had single-vessel CAD, emergency, no stent, prior bypass graft or myocardial infarction <24h. Diabetes-effect was derived from 9-year all-cause mortality and re-intervention risk-adjusted hazard ratios [AHR (95% confidence intervals)] for DES (N=2679; 48% three-vessel; 39% DM) and BMS (N=2651; 40% three-vessel; 33% DM) and then stratified based on stent (DES/BMS) and vessel disease (two/three).


RESULTS
Diabetes-effect on mortality was lower for DES (AHRDM/NoDM=1.41 [1.14-1.74]) versus BMS (AHRDM/NoDM=1.71 [1.50-2.01]), but this was predominantly driven by two-vessel patients. This diabetes effect was similar for first (DES1: AHRDM/NoDM=1.43 [1.14-1.79]) and second (DES2: AHRDM/NoDM=1.53 [0.77-3.07]) generation DES. Re-intervention comparisons were similarly increased by diabetes in all sub-cohorts.


CONCLUSIONS
Our analysis of a large real-world PCI series indicates that diabetes is associated with worse 9-year mortality irrespective of stent type, albeit this is mitigated to varying degrees with DES, particularly in DES2 and in case of 2-vessel disease. A complementary stent-effect analysis confirmed DES-to-BMS and DES2-to-DES1 superiority in both diabetics and non-diabetics.
Department of Internal Medicine, Vascular Medicine Program and Outcomes Research Unit, American University of Beirut, Lebanon.
Sanaa A
SA
Badour
Divisions of Cardiology, Mount Sinai Beth Israel Medical Center, New York, NY, USA.
Kamellia R
KR
Dimitrova
Cardiothoracic Surgery, Mount Sinai Beth Israel Medical Center, New York, NY, USA.
Yumiko
Y
Kanei
Divisions of Cardiology, Mount Sinai Beth Israel Medical Center, New York, NY, USA.
Robert F
RF
Tranbaugh
Department of Internal Medicine, Vascular Medicine Program and Outcomes Research Unit, American University of Beirut, Lebanon.
Mark M
MM
Hajjar
Division of Cardiology, Mercy Saint Vincent Medical Center, Toledo, OH, USA.
Ameer
A
Kabour
Department of Surgery, University of Toledo College of Medicine, Toledo, OH, USA.
Thomas A
TA
Schwann
Department of Internal Medicine, Vascular Medicine Program and Outcomes Research Unit, American University of Beirut, Lebanon.
Samir
S
Alam
Department of Internal Medicine, Vascular Medicine Program and Outcomes Research Unit, American University of Beirut, Lebanon.
Kamal
K
Badr
Department of Internal Medicine, Vascular Medicine Program and Outcomes Research Unit, American University of Beirut, Lebanon. Electronic address: rh106@aub.edu.lb.
Robert H
RH
Habib
D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D019233:Retreatment; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
Bare metal stent; New generation DES; Percutaneous coronary intervention; Survival analysis