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Catheter Cardiovasc Interv. 2016 Jan 1;87(1):52-62. doi: 10.1002/ccd.26026. Epub 2015 May 27.

One-year clinical outcomes after sirolimus-eluting coronary stent implantation in diabetics enrolled in the worldwide e-SELECT registry.

Author information

1
Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy.
2
Instituto Dante Pazzanese De Cardiologia, Sao Paolo, Brazil.
3
John Radcliffe Hospital, Oxford, United Kingdom.
4
Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.
5
Cleveland Clinic Foundation, Cleveland, Ohio.
6
Cardiovascular Institute and Fu Wai Hospital, Beijing, China.
7
Mayo Clinic, Rochester, Minnesota.
8
The Heart Center of Chonnam National University Hospital, Gwang Ju, Korea.
9
Centre Hospitalier Universitaire, Liège, Belgium.
10
Universitäts-Herzzentrum Freiburg, Bad Krozingen, Germany.
11
Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris Descartes University and INSERM, U 970, Paris, France.
12
Cardiovascular Investigation Unit Royal Adelaide Hospital, Adelaide, Australia.
13
La Tour Hospital, Geneva, Switzerland.

Abstract

BACKGROUND:

Diabetes mellitus has worse outcome after percutaneous coronary intervention.

AIM:

We assessed stent thrombosis (ST), major adverse cardiac events (MACE), and major bleeding rates at 1 year after implantation of sirolimus-eluting stents (SES) in patients with diabetes mellitus in a large multicenter registry.

METHODS:

From May 2006 to April 2008, 15,147 unselected consecutive patients were enrolled at 320 centers in 56 countries in a prospective, observational registry after implantation of ≥ 1 SES. Source data were verified in 20% randomly chosen patients at > 100 sites. Adverse events were adjudicated by an independent Clinical Event Committee.

RESULTS:

Complete follow-up at 1 year was obtained in 13,693 (92%) patients, 4,577 (30%) of whom were diabetics. Within diabetics, 1,238 (9%) were insulin-treated diabetics (ITD). Diabetics were older (64 vs. 62 years, P < 0.001), with higher incidence of major coronary risk factors, co-morbidities, and triple-vessel coronary artery disease. Coronary lesions had smaller reference vessel diameter (2.88 ± 0.46 vs. 2.93 ± 0.45 mm, P < 0.001) and were more often heavily calcified (26.1% vs. 22.6%, P < 0.001). At 1 year, diabetics had higher MACE rate (6.8% vs. 3.9%, P < 0.001) driven by ITD (10.6% vs. 5.5%, P < 0.001). Finally, diabetics had significant increase in ST (1.7% vs. 0.7%, P < 0.001), principally owing to ITD (3.4% vs. 1.1%, P < 0.001). There was an overall low risk of major bleeding during follow-up, without significant difference among subgroups.

CONCLUSIONS:

In the e-SELECT registry, diabetics represented 30% of patients undergoing SES implantation and had significantly more co-morbidities and complex coronary lesions. Although 1-year follow-up documented good overall outcome in diabetics, higher ST and MACE rates were observed, mainly driven by ITD. © 2015 Wiley Periodicals, Inc.

KEYWORDS:

antithrombotic therapy; bleeding complications; diabetes mellitus; percutaneous coronary intervention; sirolimus-eluting stent; stent thrombosis

PMID:
26012537
DOI:
10.1002/ccd.26026
[Indexed for MEDLINE]
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