Abstract 2809: Insulin-Treated Diabetic Patients Have Attenuated Benefit of Drug-Eluting Stents After Percutaneous Coronary Intervention: A Report from the NHLBI Dynamic Registry
Background: Insulin-treated diabetic patients have elevated adverse event raets after percutaneous coronary interventions (PCI). Drug-eluting stents (DES) reduce restenosis in diabetic patients compared to bare-metal stents (BMS); however, we hypothesized that insulin-treated patients would not have a similar magnitude of benefit from DES as non-insulin treated diabetic patients.
Methods: We analyzed baseline clinical and angiographic characteristics and in-hospital and 1-year outcomes of 1914 diabetic patients in the NHLBI Dynamic Registry of PCI. Subjects were stratified according to diabetic therapy (insulin-treated vs non-insulin-treated) and stent type (DES vs BMS).
Results: Insulin-treated subjects were older, more likely female, and had more comorbid conditions. Angiographic success and number of lesions treated did not vary significantly. Adjusted 1-year outcome analysis in stented patients demonstrated that non-insulin-treated patients who received a DES had significantly less repeat revascularization [HR 0.42 (0.28 – 0.62, 95% CI), p=0.001]; however, the benefit of DES among insulin-treated subjects was lower (Figure⇓) revealing a non-significant trend towards less repeat revascularization [HR 0.67 (0.42–1.06, 95% CI), p<0.12].
Conclusions: Among diabetic patients, those treated with insulin had similar angiographic success but worse 1-year outcomes than those not on insulin therapy. While there is a trend towards benefit of DES in the insulin-treated group, the benefit appears to be attenuated compared with non-insulin treated subjects. Further studies are needed to validate these findings and to investigate possible mechanisms.