Impact of diabetes on long-term outcome after primary angioplasty: Insights from the DESERT cooperation

Giuseppe De Luca*, Maurits T. Dirksen, Christian Spaulding, Henning Kelbæk, Martin Schalij, Leif Thuesen, Bas Van Der Hoeven, Marteen A. Vink, Christoph Kaiser, Carmine Musto, Tania Chechi, Gaia Spaziani, Luis Salvador Diaz De La Llera, Vincenzo Pasceri, Emilio Di Lorenzo, Roberto Violini, Harry Suryapranata, Gregg W. Stone

*Corresponding author af dette arbejde

    Publikation: Bidrag til tidsskriftArtikelForskningpeer review

    Abstrakt

    OBJECTIVE-Diabetes has been shown to be associated with worse survival and repeat target vessel revascularization (TVR) after primary angioplasty. The aim of the current study was to evaluate the impact of diabetes on long-term outcome in patients undergoing primary angioplasty treated with bare metal stents (BMS) and drug-eluting stents (DES). RESEARCH DESIGN AND METHODS-Our population is represented by 6,298 STsegment elevation myocardial infarction (STEMI) patients undergoing primary angioplasty included in the DESERT database from 11 randomized trials comparing DES with BMS. RESULTS-Diabetes was observed in 972 patients (15.4%) who were older (P<0.001), more likely to be female (P < 0.001), with higher prevalence of hypertension (P < 0.001), hypercholesterolemia (P < 0.001), and longer ischemia time (P < 0.001), and without any difference in angiographic and procedural characteristics. At long-term follow-up (1,201 ± 441 days), diabetes was associated with higher rates of death (19.1% vs. 7.4%; P < 0.0001), reinfarction (10.4% vs. 7.5%; P<0.001), stent thrombosis (7.6% vs. 4.8%; P = 0.002) with similar temporal distributiondacute, subacute, late, and very latedbetween diabetic and control patients, and TVR (18.6% vs. 15.1%; P = 0.006). These results were confirmed in patients receiving BMS or DES, except for TVR, there being no difference observed between diabetic and nondiabetic patients treated with DES. The impact of diabetes on outcome was confirmed after correction for baseline confounding factors (mortality, P < 0.001; repeat myocardial infarction, P = 0.006; stent thrombosis, P = 0.007; TVR, P = 0.027). CONCLUSIONS-This study shows that among STEMI patients undergoing primary angioplasty, diabetes is associated with worse long-term mortality, reinfarction, and stent thrombosis in patients receiving DES and BMS. DES implantation, however, does mitigate the known deleterious effect of diabetes on TVR after BMS.

    OriginalsprogEngelsk
    Sider (fra-til)1020-1025
    Antal sider6
    TidsskriftDiabetes Care
    Vol/bind36
    Udgave nummer4
    DOI
    StatusUdgivet - 1 apr. 2013

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