Abstract 2530: Outcomes of Percutaneous Coronary Intervention across Angioplasty, Bare Metal Stents and Drug Eluting Stents in Patients with Diabetes
Outcomes in patients with diabetes mellitus (DM) undergoing percutaneous coronary interventions (PCIs) are worse, despite advances from balloon angioplasty (BA), to bare metal stents (BMS) and then to drug eluting stents (DES). The impact of successive PCI modalities and pharmacological therapy on outcomes among patients with diabetes in real world routine practice remains of considerable interest. Baseline patient, procedural and outcome data among patients with DM undergoing de novo PCI enrolled in both the NHLBI PTCA Registry (1985–1986) and the subsequent contemporary Dynamic Registry Waves (1997–2006) were compared by device era. BA (n=459) patients were comprised from the PTCA registry and wave 1 (1997–98), BMS (n=795) patients were included from waves 1, 2 and 3 (1997–2002) and DES (n= 592) were included from waves 4 and 5 (2004 – 06). Significant differences were observed in patient and disease characteristics by device use (table⇓). On average, patients with BMS or DES were more likely to be discharged on more medications (aspirin, ACE-I, beta blockers, statins, ticlopidine/clopidogrel) compared to the BA group. Cumulative 1 year event rates for BA, BMS and DES use respectively were - Death/MI: 16.2%, 13.3 %, 10.1 % (p< 0.01) and Repeat Revascularization: 29.7%, 20.2%, 13.0% (p < 0.001). Multivariable analysis (table⇓) showed significant reduction in risk of Death/MI and Repeat revascularization for BMS and DES, when compared to BA use. This improvement was also seen with DES use, when BMS was used as a reference group. Outcomes for patients with diabetes undergoing de novo PCI have improved across the eras of BA, BMS and DES use. Concurrent improvement in pharmacologic therapy may have played an important role in the improvement of death and MI across these eras.