Key result
The drug-eluting stent era was associated with a 41% adjusted relative risk reduction (HR 0.59) in 3-year cardiovascular events compared to the plain old balloon angioplasty era in diabetic patients.
Why the study?
Does PCI in the DES era improve 3-year cardiovascular outcomes compared to the POBA and BMS eras in patients with diabetes?
Cohort (n=1,584)
No
Does PCI in the DES era improve 3-year cardiovascular outcomes compared to the POBA and BMS eras in patients with diabetes?
Hazard Ratio: 0.59 (95% CI 0.42–0.85)
p-value: p=0.004
Clinical outcomes for diabetic patients undergoing PCI have significantly improved over time from the POBA to the DES era, despite increasingly complex patient risk profiles.
Improved PCI outcomes in diabetes over eras may inform expectations; leaves open specific benefits of drug-eluting stents.
Objective Diabetes is a negative predictor in coronary artery disease patients. Since the introduction of percutaneous coronary intervention (PCI), PCI has evolved through technological advances in devices, improvements in operators' techniques and the establishment of effective therapeutic protocols. The aim of this study is to examine the changes in the clinical outcomes following PCI in patients with diabetes. Methods We compared the clinical outcomes in patients with diabetes following PCI from 1984 to 2010 at Juntendo University over three eras (plain old balloon angioplasty (POBA)-, bare metal stents (BMS)- and drug-eluting stents (DES)-eras). The primary endpoint was a composite of all-cause mortality, non-fatal myocardial infarction, non-fatal stroke and repeat revascularization within 3 years after the index PCI. Results A total of 1,584 patients were examined. The baseline characteristics became unfavorable over time with regard to age, prevalence of hypertension, presentation with acute coronary syndrome and a reduced left ventricular ejection fraction. The administration of aspirin, statins and -blockers increased over time. The event-free survival rate for the 3-year cardiovascular events was lower in the DES-era. The adjusted relative risk reduction for 3-year cardiovascular events was 46 % in the DES-era compared with the POBA-era. Conclusion The incidence of 3-year cardiovascular events decreased from 1984 to 2010 in patients with diabetes following PCI, despite the higher risk profiles in the DES-era.
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Naito et al. (2016) conducted a cohort in Diabetes mellitus and coronary artery disease (n=1,584). Drug-eluting stents (DES) era vs. Plain old balloon angioplasty (POBA) era was evaluated on Composite of all-cause mortality, non-fatal myocardial infarction, non-fatal stroke and repeat revascularization within 3 years after the index PCI (HR 0.59, 95% CI 0.42-0.85, p=0.004). The drug-eluting stent era was associated with a 41% adjusted relative risk reduction (HR 0.59) in 3-year cardiovascular events compared to the plain old balloon angioplasty era in diabetic patients.
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