Elvin Kedhi1, Philippe Généreux2, Tullio Palmerini3, Thomas C McAndrew4, Helen Parise4, Roxana Mehran5, George D Dangas5, Gregg W Stone6. 1. Isala Klinieken, Zwolle, the Netherlands. 2. New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada. 3. Dipartimento Cardiovascolare, Policlinico Sant' Orsola, Bologna, Italy. 4. Cardiovascular Research Foundation, New York, New York. 5. Cardiovascular Research Foundation, New York, New York; Icahn School of Medicine at Mount Sinai, New York, New York. 6. New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York. Electronic address: gs2184@columbia.edu.
Abstract
OBJECTIVES: The aim of this study was to investigate whether baseline lesion complexity affects drug-eluting stent (DES) outcomes according to diabetic status. BACKGROUND: Previous studies have reported conflicting results regarding DES safety and efficacy in patients with and without diabetes mellitus (DM). METHODS: Patient-level data from 18 prospective randomized trials were pooled. DES treatment outcomes in patients with versus without DM were analyzed in 2 propensity score-matched groups further stratified according to lesion complexity (American College of Cardiology and American Heart Association class A/B1 vs. B2/C). Remaining baseline differences were adjusted for by multivariate analysis. RESULTS:DM was present in 3,467 of 18,441 patients (18.8%). DM was a predictor of 1-year repeat revascularization (target lesion revascularization: hazard ratio: 1.34; 95% confidence interval: 1.05 to 1.70; target vessel revascularization: hazard ratio: 1.40; 95% confidence interval: 1.15 to 1.72) and cardiac death or myocardial infarction (hazard ratio: 1.40; 95% confidence interval: 1.09 to 1.81). Rates of target lesion and target vessel revascularization were significantly higher in patients with versus those without DM with type B2/C lesions (8.0% vs. 4.5% and 10.6% vs. 5.9%, respectively, p < 0.0001 for both), but not in patients with only type A/B1 lesions (4.6% vs. 4.8%, p = 0.87, and 7.4% vs. 6.8%, p = 0.47, respectively), with a significant interaction between DM and lesion type observed for both endpoints (p = 0.01 and p = 0.02, respectively). No interaction was observed for death or myocardial infarction (p = 0.28). CONCLUSIONS: In the DES era, patients with DM remain at increased risk for cardiac death or myocardial infarction. However, DM is a risk factor for repeat revascularization only in those patients with complex lesions; patients with DM and noncomplex lesions have similar rates of 1-year freedom from repeat revascularization as do patients without DM.
RCT Entities:
OBJECTIVES: The aim of this study was to investigate whether baseline lesion complexity affects drug-eluting stent (DES) outcomes according to diabetic status. BACKGROUND: Previous studies have reported conflicting results regarding DES safety and efficacy in patients with and without diabetes mellitus (DM). METHODS:Patient-level data from 18 prospective randomized trials were pooled. DES treatment outcomes in patients with versus without DM were analyzed in 2 propensity score-matched groups further stratified according to lesion complexity (American College of Cardiology and American Heart Association class A/B1 vs. B2/C). Remaining baseline differences were adjusted for by multivariate analysis. RESULTS:DM was present in 3,467 of 18,441 patients (18.8%). DM was a predictor of 1-year repeat revascularization (target lesion revascularization: hazard ratio: 1.34; 95% confidence interval: 1.05 to 1.70; target vessel revascularization: hazard ratio: 1.40; 95% confidence interval: 1.15 to 1.72) and cardiac death or myocardial infarction (hazard ratio: 1.40; 95% confidence interval: 1.09 to 1.81). Rates of target lesion and target vessel revascularization were significantly higher in patients with versus those without DM with type B2/C lesions (8.0% vs. 4.5% and 10.6% vs. 5.9%, respectively, p < 0.0001 for both), but not in patients with only type A/B1 lesions (4.6% vs. 4.8%, p = 0.87, and 7.4% vs. 6.8%, p = 0.47, respectively), with a significant interaction between DM and lesion type observed for both endpoints (p = 0.01 and p = 0.02, respectively). No interaction was observed for death or myocardial infarction (p = 0.28). CONCLUSIONS: In the DES era, patients with DM remain at increased risk for cardiac death or myocardial infarction. However, DM is a risk factor for repeat revascularization only in those patients with complex lesions; patients with DM and noncomplex lesions have similar rates of 1-year freedom from repeat revascularization as do patients without DM.
Authors: Maayan Konigstein; Mahesh V Madhavan; Ori Ben-Yehuda; Hussein M Rahim; Iva Srdanovic; Fotis Gkargkoulas; Ghazaleh Mehdipoor; Evan Shlofmitz; Akiko Maehara; Björn Redfors; Ankita K Gore; Thomas McAndrew; Gregg W Stone; Ziad A Ali Journal: Am Heart J Date: 2019-04-12 Impact factor: 4.749
Authors: Mark W Kennedy; Enrico Fabris; Alexander J Ijsselmuiden; Holger Nef; Sebastian Reith; Javier Escaned; Fernando Alfonso; Niels van Royen; Wojtek Wojakowski; Adam Witkowski; Ciro Indolfi; Jan Paul Ottervanger; Harry Suryapranata; Elvin Kedhi Journal: Cardiovasc Diabetol Date: 2016-10-10 Impact factor: 9.951
Authors: István F Édes; Zoltán Ruzsa; György Szabó; Sándor Nardai; Dávid Becker; Kálmán Benke; Bálint Szilveszter; Béla Merkely Journal: Catheter Cardiovasc Interv Date: 2015-05-29 Impact factor: 2.692
Authors: Damian Kawecki; Beata Morawiec; Janusz Dola; Wojciech Wańha; Grzegorz Smolka; Aleksandra Pluta; Kamil Marcinkiewicz; Andrzej Ochała; Ewa Nowalany-Kozielska; Wojciech Wojakowski Journal: Med Sci Monit Date: 2015-10-27