Impact of Coronary Lesion Complexity on Drug-Eluting Stent Outcomes in Patients With and Without Diabetes Mellitus

被引：88

作者：

Kedhi, Elvin ^{[1
]}

Genereux, Philippe ^{[2
,3
,4
]}

Palmerini, Tullio ^{[5
]}

McAndrew, Thomas C. ^{[3
]}

Parise, Helen ^{[3
]}

Mehran, Roxana ^{[3
,6
]}

Dangas, George D. ^{[3
,6
]}

Stone, Gregg W. ^{[2
,3
]}

机构：

[1] Isala Klin, Zwolle, Netherlands

[2] Columbia Univ, Med Ctr, New York Presbyterian Hosp, New York, NY USA

[3] Cardiovasc Res Fdn, New York, NY 10022 USA

[4] Hop Sacre Coeur, Montreal, PQ H4J 1C5, Canada

[5] Policlin St Orsola, Dipartimento Cardiovasc, Bologna, Italy

[6] Icahn Sch Med Mt Sinai, New York, NY USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2014年 / 63卷 / 20期

关键词：

diabetes mellitus; drug-eluting stent(s); prognosis; RANDOMIZED CONTROLLED-TRIAL; ACUTE MYOCARDIAL-INFARCTION; BARE-METAL STENTS; ARTERY-DISEASE; DOUBLE-BLIND; ATHEROSCLEROTIC LESIONS; METABOLIC SYNDROME; SLOW-RELEASE; IV TRIAL; REVASCULARIZATION;

D O I：

10.1016/j.jacc.2014.01.064

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The aim of this study was to investigate whether baseline lesion complexity affects drug-eluting stent (DES) outcomes according to diabetic status. Background Previous studies have reported conflicting results regarding DES safety and efficacy in patients with and without diabetes mellitus (DM). Methods Patient-level data from 18 prospective randomized trials were pooled. DES treatment outcomes in patients with versus without DM were analyzed in 2 propensity score-matched groups further stratified according to lesion complexity (American College of Cardiology and American Heart Association class A/B1 vs. B2/C). Remaining baseline differences were adjusted for by multivariate analysis. Results DM was present in 3,467 of 18,441 patients (18.8%). DM was a predictor of 1-year repeat revascularization (target lesion revascularization: hazard ratio: 1.34; 95% confidence interval: 1.05 to 1.70; target vessel revascularization: hazard ratio: 1.40; 95% confidence interval: 1.15 to 1.72) and cardiac death or myocardial infarction (hazard ratio: 1.40; 95% confidence interval: 1.09 to 1.81). Rates of target lesion and target vessel revascularization were significantly higher in patients with versus those without DM with type B2/C lesions (8.0% vs. 4.5% and 10.6% vs. 5.9%, respectively, p < 0.0001 for both), but not in patients with only type A/B1 lesions (4.6% vs. 4.8%, p = 0.87, and 7.4% vs. 6.8%, p = 0.47, respectively), with a significant interaction between DM and lesion type observed for both endpoints (p = 0.01 and p = 0.02, respectively). No interaction was observed for death or myocardial infarction (p = 0.28). Conclusions In the DES era, patients with DM remain at increased risk for cardiac death or myocardial infarction. However, DM is a risk factor for repeat revascularization only in those patients with complex lesions; patients with DM and noncomplex lesions have similar rates of 1-year freedom from repeat revascularization as do patients without DM. (c) 2014 by the American College of Cardiology Foundation

引用

页码：2111 / 2118

页数：8

共 39 条

[1] Outcomes with various drug eluting or bare metal stents in patients with diabetes mellitus: mixed treatment comparison analysis of 22 844 patient years of follow-up from randomised trials [J].

Bangalore, Sripal ;

Kumar, Sunil ;

Fusaro, Mario ;

Amoroso, Nicholas ;

Kirtane, Ajay J. ;

Byrne, Robert A. ;

Williams, David O. ;

Slater, James ;

Cutlip, Donald E. ;

Feit, Frederick .

BMJ-BRITISH MEDICAL JOURNAL, 2012, 345

[2] Long-term clinical and angiographic outcomes of diabetic patients after revascularization with early generation drug-eluting stents [J].

Billinger, Michael ;

Raeber, Lorenz ;

Hitz, Sarah ;

Stefanini, Giulio G. ;

Pilgrim, Thomas ;

Stettler, Christoph ;

Zanchin, Thomas ;

Pulver, Cedric ;

Pfaeffli, Nico ;

Eberli, Franz ;

Meier, Bernhard ;

Kalesan, Bindu ;

Jueni, Peter ;

Windecker, Stephan .

AMERICAN HEART JOURNAL, 2012, 163 (05) :876-+

[3] Randomized study to assess the effectiveness of slow- and moderate-release polymer-based paclitaxel-eluting stents for coronary artery lesions [J].

Colombo, A ;

Drzewiecki, J ;

Banning, A ;

Grube, E ;

Hauptmann, K ;

Silber, S ;

Dudek, D ;

Fort, S ;

Schiele, F ;

Zmudka, K ;

Guagliumi, G ;

Russell, ME .

CIRCULATION, 2003, 108 (07) :788-794

[4] Clinical end points in coronary stent trials - A case for standardized definitions [J].

Cutlip, Donald E. ;

Windecker, Stephan ;

Mehran, Roxana ;

Boam, Ashley ;

Cohen, David J. ;

van Es, Gerrit-Anne ;

Steg, P. Gabriel ;

Morel, Marie-angele ;

Mauri, Laura ;

Vranckx, Pascal ;

McFadden, Eugene ;

Lansky, Alexandra ;

Hamon, Martial ;

Krucoff, Mitchell W. ;

Serruys, Patrick W. .

CIRCULATION, 2007, 115 (17) :2344-2351

[5] Clinical efficacy of polymer-based paclitaxel-eluting stents in the treatment of complex, long coronary artery lesions from a multicenter, randomized trial - Support for the use of drug-eluting Stents in contemporary clinical practice [J].

Dawkins, KD ;

Grube, E ;

Guagliumi, G ;

Banning, AP ;

Zmudka, K ;

Colombo, A ;

Thuesen, L ;

Hauptman, K ;

Marco, J ;

Wijns, W ;

Popma, JJ ;

Koglin, J ;

Russell, ME .

CIRCULATION, 2005, 112 (21) :3306-3313

[6] Diabetes mellitus and the clinical and angiographic outcome after coronary stent placement [J].

Elezi, S ;

Kastrati, A ;

Pache, J ;

Wehinger, A ;

Hadamitzky, M ;

Dirschinger, J ;

Neumann, FJ ;

Schömig, A .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1998, 32 (07) :1866-1873

[7] Randomized, double-blind, multicenter study of the Endeavor zotarolimus-eluting phosphorylcholine encapsulated stent for treatment of native coronary artery lesions:: Clinical and angiographic results of the ENDEAVOR II trial [J].

Fajadet, Jean ;

Wijns, William ;

Laarman, Gert-Jan ;

Kuck, Karl-Heinz ;

Ormiston, John ;

Munzel, Thomas ;

Popma, Jeffrey J. ;

Fitzgerald, Peter J. ;

Bonan, Raoul ;

Kuntz, Richard E. .

CIRCULATION, 2006, 114 (08) :798-806

[8] Strategies for Multivessel Revascularization in Patients with Diabetes [J].

Farkouh, Michael E. ;

Domanski, Michael ;

Sleeper, Lynn A. ;

Siami, Flora S. ;

Dangas, George ;

Mack, Michael ;

Yang, May ;

Cohen, David J. ;

Rosenberg, Yves ;

Solomon, Scott D. ;

Desai, Akshay S. ;

Gersh, Bernard J. ;

Magnuson, Elizabeth A. ;

Lansky, Alexandra ;

Boineau, Robin ;

Weinberger, Jesse ;

Ramanathan, Krishnan ;

Sousa, J. Eduardo ;

Rankin, Jamie ;

Bhargava, Balram ;

Buse, John ;

Hueb, Whady ;

Smith, Craig R. ;

Muratov, Victoria ;

Bansilal, Sameer ;

King, Spencer, III ;

Bertrand, Michel ;

Fuster, Valentin .

NEW ENGLAND JOURNAL OF MEDICINE, 2012, 367 (25) :2375-2384

[9] Multiple complex coronary atherosclerosis in diabetic patients with acute myocardial infarction: a three-vessel optical coherence tomography study [J].

Fukunaga, Masashi ;

Fujii, Kenichi ;

Nakata, Tsuyoshi ;

Shibuya, Masahiko ;

Miki, Kojiro ;

Kawasaki, Daizo ;

Masutani, Motomaru ;

Kawabata-Lee, Masaaki ;

Ohyanagi, Mitsumasa ;

Masuyama, Tohru .

EUROINTERVENTION, 2012, 8 (08) :955-961

[10] Quantification and Impact of Untreated Coronary Artery Disease After Percutaneous Coronary Intervention The Residual SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) Score [J].

Genereux, Philippe ;

Palmerini, Tullio ;

Caixeta, Adriano ;

Rosner, Gregg ;

Green, Philip ;

Dressler, Ovidiu ;

Xu, Ke ;

Parise, Helen ;

Mehran, Roxana ;

Serruys, Patrick W. ;

Stone, Gregg W. .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2012, 59 (24) :2165-2174

← 1 2 3 4 →