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).
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.
Effect estimate: HR 1.25 (95% CI 1.03-1.53)
Absolute Event Rate: 14.5% vs 9.9%
p-value: p=0.026
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%; P11 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.
Koskinas et al. (Fri,) 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).