Key result
Diabetes is not associated with increased 1-year MACE after multivessel DES PCI.
Why the study?
Diabetes is associated with significantly worse outcomes after multivessel PCI, for which coronary bypass surgery is recommended as the preferred option, motivating a comparison of clinical outcomes in patients with and without diabetes undergoing multivessel PCI with DES.
Observational (n=722)
Yes
Diabetes linked to higher events post-multivessel PCI; leaves open whether CABG superiority persists with modern stents.
OBJECTIVES: To compare clinical outcomes in patients with and without diabetes after multivessel percutaneous coronary intervention (PCI). BACKGROUND: Diabetes is associated with significantly worse outcomes after multivessel PCI and coronary bypass surgery is recommended as the preferred option for these patients. METHODS AND RESULTS: The Evaluation of Drug Eluting Stents and Ischemic Events registry is a multicenter evaluation of acute and 1 year outcomes in unselected patients undergoing PCI since approval of drug-eluting stents (DES). Major adverse cardiac events (MACE) were defined as all cause mortality, myocardial infarction, or repeat revascularization and rate was estimated by Kaplan-Meier method and compared using log-rank. The independent correlates of MACE were determined using Cox proportional hazards regression. Of 4,819 nonemergency native coronary DES procedures, 1,595 (33.1%) were in patients with diabetes and 722 (11.7%) involved >1 vessel. Of patients undergoing multivessel procedures, diabetes was present in 256 (35.5%). One year after multivessel PCI, MACE was similar for patients with or without diabetes (22.3% versus 21.2%, log-rank test P = 0.85). The independent correlates of 1 year MACE were female sex (Hazard ratio [HR], 1.58, 95% CI 1.14-2.20), ejection fraction (HR 0.74 per group [<25%, 26-35%, 36-50%, and >50%], 95%CI 0.59-0.94) and number of stents (HR 1.20 per stent, 95%CI 1.04-1.38) but not diabetes (HR 1.00, 95% CI 0.71-1.39). CONCLUSIONS: Multivessel DES is performed commonly in patients with diabetes with outcomes at 1 year similar to patients without diabetes. Longer follow-up is required to more fully evaluate the safety and effectiveness of this strategy.
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Novack et al. (2008) conducted an observational in Multivessel coronary artery disease treated with drug-eluting stents (with vs. without diabetes mellitus) (n=722). Diabetes mellitus in patients undergoing multivessel drug-eluting stent PCI vs. Patients without diabetes mellitus undergoing multivessel drug-eluting stent PCI was evaluated on Major adverse cardiac events (all-cause mortality, myocardial infarction, or repeat revascularization) at 1 year (HR 1.00, 95% CI 0.71-1.39, p=0.85). Diabetes mellitus was not associated with increased 1-year MACE after multivessel drug-eluting stent PCI compared with no diabetes (22.3% vs 21.2%; HR 1.00; 95% CI 0.71-1.39; P=0.85).
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