Key result
Diabetic patients undergoing PCI with drug-eluting stents had a higher risk of major adverse cardiac events at 2 years compared to nondiabetic patients (HR 1.25; 95% CI 1.03-1.53; P=0.026).
Why the study?
Does diabetic status increase the risk of major adverse cardiac events in patients undergoing PCI with drug-eluting stents across different levels of coronary artery disease complexity?
Meta-Analysis (n=6,081)
Yes
Does diabetic status increase the risk of major adverse cardiac events in patients undergoing PCI with drug-eluting stents across different levels of coronary artery disease complexity?
Diabetic patients undergoing PCI with drug-eluting stents remain at increased risk for target-lesion revascularization and MACE compared to nondiabetics, independent of baseline SYNTAX score.
Answers are grounded in this paper and cite their sources.
Diabetics face higher MACE risk after PCI with DES independent of SYNTAX score; confirms diabetes as persistent independent predictor.
BACKGROUND: Diabetes mellitus and angiographic coronary artery disease complexity are intertwined and unfavorably affect prognosis after percutaneous coronary interventions, but their relative impact on long-term outcomes after percutaneous coronary intervention with drug-eluting stents remains controversial. This study determined drug-eluting stents outcomes in relation to diabetic status and coronary artery disease complexity as assessed by the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score. METHODS AND RESULTS: In a patient-level pooled analysis from 4 all-comers trials, 6081 patients were stratified according to diabetic status and according to the median SYNTAX score ≤11 or >11. The primary end point was major adverse cardiac events, a composite of cardiac death, myocardial infarction, and clinically indicated target lesion revascularization within 2 years. Diabetes mellitus was present in 1310 patients (22%), and new-generation drug-eluting stents were used in 4554 patients (75%). Major adverse cardiac events occurred in 173 diabetics (14.5%) and 436 nondiabetic patients (9.9%; P<0.001). In adjusted Cox regression analyses, SYNTAX score and diabetes mellitus were both associated with the primary end point (P<0.001 and P=0.028, respectively; P for interaction, 0.07). In multivariable analyses, diabetic versus nondiabetic patients had higher risks of major adverse cardiac events (hazard ratio, 1.25; 95% confidence interval, 1.03-1.53; P=0.026) and target lesion revascularization (hazard ratio, 1.54; 95% confidence interval, 1.18-2.01; P=0.002) but similar risks of cardiac death (hazard ratio, 1.41; 95% confidence interval, 0.96-2.07; P=0.08) and myocardial infarction (hazard ratio, 0.89; 95% confidence interval, 0.64-1.22; P=0.45), without significant interaction with SYNTAX score ≤11 or >11 for any of the end points. CONCLUSIONS: In this population treated with predominantly new-generation drug-eluting stents, diabetic patients were at increased risk for repeat target-lesion revascularization consistently across the spectrum of disease complexity. The SYNTAX score was an independent predictor of 2-year outcomes but did not modify the respective effect of diabetes mellitus. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00297661, NCT00389220, NCT00617084, and NCT01443104.
No takes yet. Share an insight, caveat, or question.
Koskinas et al. (2016) conducted a meta-analysis in Coronary artery disease (n=6,081). Diabetes mellitus vs. Nondiabetic patients was evaluated on Major adverse cardiac events, a composite of cardiac death, myocardial infarction, and clinically indicated target lesion revascularization within 2 years (HR 1.25, 95% CI 1.03-1.53, p=0.026). Diabetic patients undergoing PCI with drug-eluting stents had a higher risk of major adverse cardiac events at 2 years compared to nondiabetic patients (HR 1.25; 95% CI 1.03-1.53; P=0.026).
Synapse has enriched 10 related papers. Consider them for comparative context: