TY - JOUR
T1 - Impact of diabetes on long-term outcome after primary angioplasty
T2 - Insights from the DESERT cooperation
AU - De Luca, Giuseppe
AU - Dirksen, Maurits T.
AU - Spaulding, Christian
AU - Kelbæk, Henning
AU - Schalij, Martin
AU - Thuesen, Leif
AU - Van Der Hoeven, Bas
AU - Vink, Marteen A.
AU - Kaiser, Christoph
AU - Musto, Carmine
AU - Chechi, Tania
AU - Spaziani, Gaia
AU - De La Llera, Luis Salvador Diaz
AU - Pasceri, Vincenzo
AU - Di Lorenzo, Emilio
AU - Violini, Roberto
AU - Suryapranata, Harry
AU - Stone, Gregg W.
PY - 2013/4/1
Y1 - 2013/4/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84875469877&partnerID=8YFLogxK
U2 - 10.2337/dc12-1507
DO - 10.2337/dc12-1507
M3 - Article
C2 - 23275351
AN - SCOPUS:84875469877
SN - 0149-5992
VL - 36
SP - 1020
EP - 1025
JO - Diabetes Care
JF - Diabetes Care
IS - 4
ER -