Two-year clinical outcomes with drug-eluting stents for diabetic patients with de novo coronary lesions - Results from a real-world multicenter registry

Article

关键词: BARE-METAL STENTS;    RANDOMIZED-TRIAL;    FOLLOW-UP;    RESTENOSIS;    IMPLANTATION;    METAANALYSIS;    REVASCULARIZATION;    INTERVENTION;    ANGIOPLASTY;    MELLITUS;   

DOI  :  10.1161/CIRCULATIONAHA.107.730416

来源: SCIE

【 摘 要 】

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.

【 授权许可】

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