Abstract 16123: Drug Eluting Stent Implantation in Multivessel Coronary Artery Disease Reduces the Adverse Effect of Diabetes on Late Outcomes When Compared to Bare Metal Stent
OBJECTIVE: Diabetes mellitus (DM) portends an increased risk of adverse early and late outcomes in patients undergoing percutaneous coronary intervention (PCI), especially in case of multivessel coronary disease (2VD or 3VD). We aimed to assess the hypothesis that the adverse diabetes effect on long term PCI outcomes is attenuated with the use of drug eluting stents (DES) compared to bare metal stents (BMS).
METHODS: We reviewed the PCI for multivessel disease experience at Mount Sinai Beth Israel Hospital. Patients were excluded if: single vessel disease, emergency, no stent, prior PCI or bypass grafts or recent myocardial infarction (<24hrs). The resulting 4806 study subjects included 2651 BMS [VD2/VD3: 60%/40%; 33% DM] and 2679 DES [VD2/VD3: 52%/48%; 39% DM] patients. Nine-year mortality and unplanned re-intervention were compared. The diabetes effect was quantified by hazard ratio [HR (95% confidence interval)] adjusted for patient characteristics calculated for each stent type (overall), and then for respective VD2 and VD3 subcohorts.
RESULTS: Diabetes was associated with significantly higher 9-year mortality [Fig A/B] and re-intervention rates for both BMS and DES. Overall adjusted DM vs No DM mortality hazard ratios were lower for DES vs BMS [HR=1.41(1.14-1.74) vs 1.71(1.46-2.01)], but this DES benefit was predominantly driven by the reduction in VD2 [HR=1.14(0.81-1.61) vs 1.72(1.39-2.14)] but not VD3 [HR=1.67(1.26-2.22) vs 1.74(1.37-2.21)] subcohorts [Fig C]. Unplanned re-interventions were equally increased in diabetics irrespective of stent or vessel disease with comparable HRs ≈ 1.2-1.3.
CONCLUSION: Our analysis of a large real-world PCI series indicates that, while diabetes adversely impacts outcomes irrespective of stent type, there is a substantial decrease in late deaths attributable to diabetes with DES compared to BMS in case of 2-vessel but not 3-vessel disease. DES did not reduce the diabetes related increase in re-intervention rates.
- Coronary artery disease
- Diabetes mellitus
- Percutaneous coronary intervention (PCI)
- Drug eluting stents
Author Disclosures: S.A. Badour: None. K.R. Dimitrova: None. Y. Kanei: None. R.F. Tranbaugh: None. M.M. Hajjar: None. A. Kabour: None. T.A. Schwann: None. R.H. Habib: None.
- © 2014 by American Heart Association, Inc.