Impact of Diabetes on Long-Term Outcome After Primary Angioplasty
Insights from the DESERT cooperation
- Giuseppe De Luca, MD1,
- Maurits T. Dirksen, MD2,
- Christian Spaulding, MD3,
- Henning Kelbæk, MD4,
- Martin Schalij, MD5,
- Leif Thuesen, MD6,
- Bas van der Hoeven, MD5,
- Marteen A. Vink, MD2,
- Christoph Kaiser, MD7,
- Carmine Musto, MD8,
- Tania Chechi, MD9,
- Gaia Spaziani, MD9,
- Luis Salvador Diaz de la Llera, MD10,
- Vincenzo Pasceri, MD11,
- Emilio Di Lorenzo, MD12,
- Roberto Violini, MD8,
- Harry Suryapranata, MD13,
- Gregg W. Stone, MD14,
- For the DESERT cooperation
- 1Division of Cardiology, Ospedale “Maggiore della Carità,” Eastern Piedmont University, Novara, Italy and Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University, Novara, Italy
- 2Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
- 3Assistance Publique-Hopitaux de Paris Cochin Hospital, Paris 5 Medical School Rene Descartes University and INSERM Unite 780 Avenir, Paris, France
- 4The Heart Center, Rigshospitalet, Copenhagen, Denmark
- 5Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- 6Cardiac Department, Skejby Hospital, Skejby, Denmark
- 7Department of Cardiology, University Hospital Basel, Switzerland
- 8Division of Cardiology, San Camillo Hospital, Rome Italy
- 9Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence, Italy
- 10Hemodynamics and Interventional Cardiology Unit, University Hospital Virgen del Rocio, Seville, Spain
- 11Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy
- 12Division of Cardiology, “S.G. Moscati,” Avellino, Italy
- 13Department of Cardiology, UMC St Radboud, Nijmegen, the Netherlands
- 14Columbia University Medical Center and the Cardiovascular Research Foundation, New York City, New York
- Corresponding author: Giuseppe De Luca,
OBJECTIVE Diabetes has been shown to be associated with worse survival and repeat target vessel revascularization (TVR) after primary angioplasty. The aim of the current study was to evaluate the impact of diabetes on long-term outcome in patients undergoing primary angioplasty treated with bare metal stents (BMS) and drug-eluting stents (DES).
RESEARCH DESIGN AND METHODS Our population is represented by 6,298 ST-segment elevation myocardial infarction (STEMI) patients undergoing primary angioplasty included in the DESERT database from 11 randomized trials comparing DES with BMS.
RESULTS Diabetes was observed in 972 patients (15.4%) who were older (P < 0.001), more likely to be female (P < 0.001), with higher prevalence of hypertension (P < 0.001), hypercholesterolemia (P < 0.001), and longer ischemia time (P < 0.001), and without any difference in angiographic and procedural characteristics. At long-term follow-up (1,201 ± 441 days), diabetes was associated with higher rates of death (19.1% vs 7.4%; P < 0.0001), reinfarction (10.4% vs 7.5%; P < 0.001), stent thrombosis (7.6% vs 4.8%; P = 0.002) with similar temporal distribution—acute, subacute, late, and very late—between diabetes and control patients, and TVR (18.6% vs 15.1%; P = 0.006). These results were confirmed in patients receiving BMS or DES, except for TVR, there being no difference observed between diabetic and nondiabetic patients treated with DES. The impact of diabetes on outcome was confirmed after correction for baseline confounding factors (mortality, P < 0.001; repeat myocardial infarction, P = 0.006; stent thrombosis, P = 0.007; TVR, P = 0.027).
CONCLUSIONS This study shows that among STEMI patients undergoing primary angioplasty, diabetes is associated with worse long-term mortality, reinfarction, and stent thrombosis in patients receiving DES and BMS. DES implantation, however, does mitigate the known deleterious effect of diabetes on TVR after BMS.
- Received July 27, 2012.
- Accepted September 26, 2012.
- © 2013 by the American Diabetes Association.
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