Document Detail


Two-year clinical outcomes with drug-eluting stents for diabetic patients with de novo coronary lesions: results from a real-world multicenter registry.
MedLine Citation:
PMID:  18250265     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The long-term effectiveness of drug-eluting stents (DES) in unselected diabetics in routine practice is currently unclear. METHODS AND RESULTS: To evaluate the long-term effectiveness of bare metal stents and DES in a real-world setting of diabetic patients, we analyzed 2-year follow-up data from all diabetic patients with de novo lesions enrolled in a prospective Web-based multicenter registry (Registro Regionale Angioplastiche dell'Emilia-Romagna; study period, 2002 to 2004) comprising all 13 hospitals performing percutaneous coronary interventions in the Emilia-Romagna region of Italy. Among the 1648 eligible patients treated with either bare metal stents alone (n=1089) or DES alone (n=559), 27% were insulin dependent and 83% had multivessel coronary disease. At 2 years, use of DES was associated with lower crude incidence of major adverse cardiac advents (all-cause mortality, nonfatal myocardial infarction, and target vessel revascularization) compared with bare metal stents (22.5% versus 28.1%; P=0.01). After propensity score adjustment, only target vessel revascularization appeared significantly lower in the DES group (11.6% versus 15.0%; hazard ratio, 0.66; 95% confidence interval, 0.46 to 0.96; P=0.041). Two-year angiographic stent thrombosis occurred in 1.5% DES patients and 0.7% of the bare-metal-stents patients (P=0.18). At Cox regression analysis, predictors of 2-year major adverse cardiac advents were left ventricular ejection fraction <35%, Charlson comorbidity index, insulin-dependent diabetes, and total lesion length. CONCLUSIONS: In this large, real-world, diabetic population, the use of DES was associated with a moderate reduction in the 2-year risk of target vessel revascularization, a benefit that was limited to non-insulin-dependent diabetic patients. Larger long-term studies are needed to clarify the long-term effectiveness and safety of such devices in diabetic patients.
Authors:
Paolo Ortolani; Marco Balducelli; Paolo Marzaroli; Giancarlo Piovaccari; Alberto Menozzi; Vincenzo Guiducci; Pietro Sangiorgio; Fabio Tarantino; Giuseppe Geraci; Fausto Castriota; Stefano Tondi; Francesco Saia; Robin M T Cooke; Paolo Guastaroba; Roberto Grilli; Antonio Marzocchi; Aleardo Maresta
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2008-02-04
Journal Detail:
Title:  Circulation     Volume:  117     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-20     Completed Date:  2008-03-17     Revised Date:  2008-11-24    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  923-30     Citation Subset:  AIM; IM    
Affiliation:
Istituto di Cardiologia, Università di Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy. paortol@tin.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary*
Combined Modality Therapy
Comorbidity
Coronary Restenosis / epidemiology
Coronary Stenosis / drug therapy*,  therapy
Coronary Thrombosis / epidemiology
Diabetes Mellitus / drug therapy
Diabetic Angiopathies / drug therapy*,  therapy
Female
Humans
Insulin / therapeutic use
Italy / epidemiology
Male
Middle Aged
Myocardial Infarction / epidemiology
Prospective Studies
Registries
Risk Factors
Sirolimus / administration & dosage,  therapeutic use*
Stents* / statistics & numerical data
Tacrolimus / administration & dosage,  therapeutic use*
Treatment Outcome
Chemical
Reg. No./Substance:
109581-93-3/Tacrolimus; 11061-68-0/Insulin; 53123-88-9/Sirolimus
Comments/Corrections
Comment In:
Circulation. 2008 Oct 28;118(18):e680; author reply e681   [PMID:  18955674 ]
Circulation. 2008 Oct 28;118(18):e679; author reply e681   [PMID:  18955673 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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