Drug-Eluting or Bare-Metal Stenting in Patients With Diabetes Mellitus Results From the Massachusetts Data Analysis Center Registry

被引:105
作者
Garg, Pallav [1 ]
Normand, Sharon-Lise T. [2 ,4 ]
Silbaugh, Treacy S. [4 ]
Wolf, Robert E. [4 ]
Zelevinsky, Katya [4 ]
Lovett, Ann [4 ]
Varma, Manu R. [1 ]
Zhou, Zheng [1 ]
Mauri, Laura [1 ,3 ,4 ]
机构
[1] Brigham & Womens Hosp, Boston, MA 02115 USA
[2] Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA
[3] Harvard Clin Res Inst, Boston, MA USA
[4] Harvard Univ, Sch Med, Boston, MA USA
关键词
angioplasty; diabetes mellitus; myocardial infarction; revascularization; stents;
D O I
10.1161/CIRCULATIONAHA.108.820159
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Patients with diabetes mellitus (DM) are at high risk for restenosis, myocardial infarction, and cardiac mortality after coronary stenting, and the long-term safety of drug-eluting stents (DES) relative to bare-metal stents (BMS) in DM is uncertain. We report on a large consecutive series of patients with DM followed up for 3 years after DES and BMS from a regional contemporary US practice with mandatory reporting. Methods and Results-All adults with DM undergoing percutaneous coronary intervention with stenting between April 1, 2003, and September 30, 2004, at all acute care nonfederal hospitals in Massachusetts were identified from a mandatory state database. According to index admission stent type, patients were classified as DES treated if all stents were drug eluting and as BMS treated if all stents were bare metal; patients treated with both types of stents were excluded from the primary analysis. Mortality rates were obtained from vital statistics records, and myocardial infarction and revascularization rates were obtained from the state database with complete 3 years of follow-up on the entire cohort. Risk-adjusted mortality, myocardial infarction, and revascularization differences (DES-BMS) were estimated with propensity-score matching based on clinical, procedural, hospital, and insurance information collected at the index admission. DM was present in 5051 patients (29% of the population) treated with DES or BMS during the study. Patients with DM were more likely to receive DES than BMS (66.1% versus 33.9%; P<0.001). The unadjusted cumulative incidence of mortality at 3 years was 14.4% in DES versus 22.2% in BMS (P<0.001). Based on propensity-score analysis of 1: 1 matched DES versus BMS patients (1476 DES: 1476 BMS), the risk-adjusted mortality, MI, and target vessel revascularization rates at 3 years were 17.5% versus 20.7% (risk difference, -3.2%; 95% confidence interval, -6.0 to -0.4; P=0.02), 13.8% versus 16.9% (-3.0%; 95% confidence interval, -5.6 to 0.5; P=0.02), and 18.4% versus 23.7% (-5.4%; confidence interval, -8.3 to -2.4; P<0.001), respectively. Conclusions-In a real-world diabetic patient population with mandatory reporting and follow-up, DES were associated with reduced mortality, myocardial infarction, and revascularization rates at long-term follow-up compared with BMS. (Circulation. 2008; 118: 2277-2285.)
引用
收藏
页码:2277 / U111
页数:16
相关论文
共 38 条
[21]  
Kornowski R, 1997, CIRCULATION, V95, P1366
[22]   Sirolimus-eluting stents versus Paclitaxel-eluting stents in the treatment of coronary artery disease in patients with diabetes mellitus [J].
Kuchulakanti, Pramod K. ;
Chu, William W. ;
Torguson, Rebecca ;
Clavijo, Leonardo ;
Wolfram, Roswitha ;
Mishra, Slindeep ;
Xue, Zhenyi ;
Gevorkian, Natalie ;
Suddath, William O. ;
Satler, Lowell F. ;
Kent, Kenneth M. ;
Pichard, Augusto D. ;
Waksman, Ron .
AMERICAN JOURNAL OF CARDIOLOGY, 2006, 98 (02) :187-192
[23]   Effect of diabetes mellitus on five-year clinical outcomes after single-vessel coronary stenting (a pooled analysis of coronary stent clinical trials) [J].
Lee, Tobias T. ;
Feinberg, Loryn ;
Baim, Donald S. ;
Holmes, David R. ;
Aroesty, Julian M. ;
Carrozza, Joseph P., Jr. ;
Cohen, David J. ;
Ho, Kalon K. L. ;
Cutlip, Donald E. .
AMERICAN JOURNAL OF CARDIOLOGY, 2006, 98 (06) :718-721
[24]   Long-Term Clinical Outcomes After Drug-Eluting and Bare-Metal Stenting in Massachusetts [J].
Mauri, Laura ;
Silbaugh, Treacy S. ;
Wolf, Robert E. ;
Zelevinsky, Katya ;
Lovett, Ann ;
Zhou, Zheng ;
Resnic, Frederic S. ;
Normand, Sharon-Lise T. .
CIRCULATION, 2008, 118 (18) :1817-U64
[25]   Drug-eluting or bare-metal stents for acute myocardial infarction [J].
Mauri, Laura ;
Silbaugh, Treacy S. ;
Garg, Pallav ;
Wolf, Robert E. ;
Zelevinsky, Katya ;
Lovett, Ann ;
Varma, Manu R. ;
Zhou, Zheng ;
Normand, Sharon-Lise T. .
NEW ENGLAND JOURNAL OF MEDICINE, 2008, 359 (13) :1330-1342
[26]   Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study [J].
Mehta, SR ;
Yusuf, S ;
Peters, RJG ;
Bertrand, ME ;
Lewis, BS ;
Natarajan, MK ;
Maimberg, K ;
Rupprecht, HJ ;
Zhao, F ;
Chrolavicius, S ;
Copland, I ;
Fox, KAA .
LANCET, 2001, 358 (9281) :527-533
[27]   New aspects in the pathogenesis of diabetic atherothrombosis [J].
Moreno, PR ;
Fuster, V .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2004, 44 (12) :2293-2300
[28]   Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery [J].
Moses, JW ;
Leon, MB ;
Popma, JJ ;
Fitzgerald, PJ ;
Holmes, DR ;
O'Shaughnessy, C ;
Caputo, RP ;
Kereiakes, DJ ;
Williams, DO ;
Teirstein, PS ;
Jaeger, JL ;
Kuntz, RE .
NEW ENGLAND JOURNAL OF MEDICINE, 2003, 349 (14) :1315-1323
[29]   Impact of sirolimus-eluting stents on outcome in diabetic patients - A SIRIUS (SIRolImUS-coated Bx Velocity balloon-expandable stent in the treatment of patients with de novo coronary artery lesions) substudy [J].
Moussa, I ;
Leon, MB ;
Baim, DS ;
O'Neill, WW ;
Popma, JJ ;
Buchbinder, M ;
Midwall, J ;
Simonton, CA ;
Keim, E ;
Wang, P ;
Kuntz, RE ;
Moses, JW .
CIRCULATION, 2004, 109 (19) :2273-2278
[30]   SILENT MYOCARDIAL-INFARCTION AND DIABETIC CARDIOVASCULAR AUTONOMIC NEUROPATHY [J].
NIAKAN, E ;
HARATI, Y ;
ROLAK, LA ;
COMSTOCK, JP ;
ROKEY, R .
ARCHIVES OF INTERNAL MEDICINE, 1986, 146 (11) :2229-2230