Impact of Routine Stenting on Clinical Outcome in Diabetic Patients Undergoing Primary Angioplasty for ST-Segment Elevation Myocardial Infarction
- Giuseppe De Luca, MD,
- Harry Suryapranata, MD,
- Jorik Timmer, MD,
- Jan Paul Ottervanger, MD,
- Arnoud W.J. van’t Hof, MD,
- Jan C.A. Hoorntje, MD,
- Jan-Henk Dambrink, MD,
- A.T. Marcel Gosselink, MD and
- Menko-Jan de Boer, MD
- Department of Cardiology, Isala Klinieken, Hospital De Weezenlanden, Zwolle, the Netherlands
- Address correspondence and reprint requests to Harry Suryapranata, MD, Isala Klinieken Hospital De Weezenlanden, Department of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, Netherlands. E-mail: h.suryapranata{at}diagram-zwolle.nl
The benefits of coronary stenting in patients with ST-segment elevation myocardial infarction (STEMI) have been related to a significant reduction in restenosis and target vessel revascularization (TVR) (1–7). However, few data have been reported in patients suffering from diabetes that have been demonstrated to be associated with in-stent restenosis and worse outcome (8–11). The Zwolle-6 (12) randomized trial investigated the actual role of routine stenting, as compared with balloon angioplasty, in a large cohort of unselected patients with STEMI without exclusion criteria. In this study, we present data in diabetic patients.
RESEARCH DESIGN AND METHODS
From April 1997 to October 2001, all patients with STEMI, who were admitted within the first 6 h or between 6 and 24 h if they had persistent symptoms with evidence of ongoing ischemia, were randomized to stenting or balloon angioplasty before the initial angiogram (12). Informed consent was obtained from each patient (or from their relatives in case of patient’s inability) before the angiogram. No exclusion criteria was applied. Our study was approved by the institutional review board. After the intervention, all patients received oral aspirin daily, with additional ticlopidine (250 mg/day) or clopidogrel (after June 1999; 300-mg loading dose followed by 75 mg/day) for 4 weeks. Diabetes was considered present if patients were treated with oral hypoglycemic agents or insulin or if the patients had a history of diabetes that was controlled by diet.
Quantitative coronary angiography was analyzed by …
