| Two-year clinical outcomes with drug-eluting stents for diabetic patients with de novo coronary lesions: results from a real-world multicenter registry. | |
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MedLine Citation:
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PMID: 18250265 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Evaluation Studies; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't Date: 2008-02-04 |
Journal Detail:
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Title: Circulation Volume: 117 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2008 Feb |
Date Detail:
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Created Date: 2008-02-20 Completed Date: 2008-03-17 Revised Date: 2008-11-24 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 923-30 Citation Subset: AIM; IM |
Affiliation:
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Istituto di Cardiologia, Università di Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy. paortol@tin.it |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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109581-93-3/Tacrolimus; 11061-68-0/Insulin; 53123-88-9/Sirolimus |
| Comments/Corrections | |
Comment In:
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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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