Abstract 2810: Impact of Diabetes Mellitus on Clinical and Angiographic Outcomes in the Drug Eluting Stent Era
It has well known that diabetes mellitus is associated with the risk of restenosis, stent thrombosis and death after percutaneous coronary interventions. We therefore analyzed angiographic and clinical outcomes of patients with diabetes mellitus who received drug-eluting stents (DES).
Methods and Results: The prospective database of 2 German hospitals was reviewed. We identified 2557 consecutive patients who underwent sirolimus-(SES) or paclitaxel-eluting (PES) stent implantation in native coronary arteries. The angiographic restenosis and 9-month adverse cardiac events, including death, myocardial infarction and target lesion revascularization (TLR) were compared between 727 diabetic and 1830 non-diabetic patients. The 30-day incidence of stent thrombosis was 1.5% in diabetic and 0.3% in non-diabetic patients (p<0.001). Nine-month mortality was higher among diabetics than among nondiabetics (4.7% vs. 3.0%, p=0.04). Whereas, the incidence of TLR was not significantly increased (9.4% in diabetic vs. 8.8% in nondiabetic patients, p=0.66). Patients with diabetes mellitus did not show significantly increased angiographic restenosis rates compared to patients without diabetes (14.9% vs. 13.4%, p=0.36). We also assessed the relative merits of SES and PES in reducing angiographic restenosis in diabetic and nondiabetic patients. While there was a significant difference in angiographic restenosis among diabetics (11.7% for SES vs. 19.2% for PES, p=0.01), this difference was eliminated among nondiabetic patients (12.4% for SES vs. 14.7% for PES, p=0.18).
Conclusions: The findings of our study clearly show that the role of diabetes mellitus as a risk factor for restenosis is markedly attenuated in the era of DES. However, differences in performance between 2 DES become more apparent in the presence of diabetes.