Abstract 15843: Do all Patients with Diabetes Mellitus Have the Same Outcome Post Percutaneous Coronary Intervention: The Impact of Lesion Complexity
Background: Patients with diabetes mellitus (DM) have usually worse outcomes post-percutaneous coronary intervention (PCI) when compared with non diabetics. This study aimed to determine the impact of lesion severity on the prognosis of DM patients post-PCI.
Methods: A total of 3,065 consecutive patients who underwent single-lesion PCI with drug-eluting stents (DES) were divided into two groups: those withn DM (n=1170) and those without DM (n=1895). Patients who had undergone multi-lesion PCI, multi-vessel PCI and those who had received a bare metal stent were excluded. The primary endpoint was major adverse cardiac events (MACE) defined as death or myocardial infarction (MI). Coronary lesion severity was defined as AHA/ACC classification: lesion type A (simple lesion), type B1/B2 (moderate complex lesion), type C (severe complex lesion).
Results: DM patients were more likely to be female, (42.9% vs. 32.9%, p <0.001), and had higher rates of hypertension (92.8% vs. 79.1%, p <0.001) and hypercholesterolemia (91.5% vs. 85.8%, p <0.001). The distribution of complex lesion was similar between the two groups. (Table) In patients with a simple lesion complexity, the incidence of MACE was similar between the two groups. However, in patients with moderate or severe lesions, the incidence of MACE was significantly higher in the DM group. (Table) After adjustment for baseline and angiographic characteristics, DM remained an independent predictor for 1-year MACE, (HR 2.2, CI 1.1 – 4.6, p=0.02) in patients with severely complex lesions.
Conclusions: Single Vessel PCI with DES in DM patients with simple lesion complexity resulted in comparable event rates to patients without DM. However, when stratified to more complex lesions, diabetes remains an independent predictor for 1-year MACE. These patients should therefore be highly considered for bypass surgery.
- © 2010 by American Heart Association, Inc.