Impact of treatment of coronary artery disease with sirolimus-eluting stents on outcomes of diabetic and nondiabetic patients

Pramod K. Kuchulakanti, Rebecca Torguson, Daniel Canos, Seung-Woon Rha, William W. Chu, Leonardo Clavijo, Regina Deible, Natalie Gevorkian, William O. Suddath, Lowell F. Satler, Kenneth M. Kent, Augusto D. Pichard, Ron Waksman

Research output: Contribution to journalArticle

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Abstract

Patients with diabetes mellitus are at increased risk for repeat interventions and mortality after coronary angioplasty and stenting. The efficacy of sirolimus-eluting stents (SESs) to improve the outcomes of these patients is a focus of interest. In the first 1,407 patients treated with SESs at our institution, 492 were diabetic (insulin dependent diabetes mellitus [IDDM], n = 160 and non-insulin-dependent DM [NIDDM], n = 332). The in-hospital and 1- and 6-month clinical outcomes were compared with those of 915 patients without DM (non-DM). The baseline characteristics were similar, except for more women, obesity, previous myocardial infarction, coronary artery bypass grafting, and renal insufficiency in the DM group (p <0.001). Compared with non-DM patients, DM patients had higher in-hospital (p <0.05) and 1-month mortality (p = 0.02). IDDM patients had more in-hospital renal failure (p = 0.04) and Q-wave myocardial infarctions (1.6% vs 0%, p = 0.04) compared with NIDDM patients, and higher mortality (3.1% vs 0.8%, p = 0.04) and subacute stent thromboses (2.3% vs 0.5%, p = 0.07) than non-DM patients at 30 days. At 6 months, DM patients had a higher incidence of Q-wave myocardial infarction, target lesion revascularization-major adverse cardiac events, and composite of death and Q-wave myocardial infarction than non-DM patients (6.0% vs 2.7%, p = 0.01). Late outcomes between the IDDM and NIDDM groups were similar. Multivariate analysis showed diabetes and acute renal failure as independent predictors of target lesion revascularization-major adverse cardiac events. In conclusion, our data showed that, despite a reduction in repeat revascularization, coronary intervention with SESs in diabetic patients is limited by higher mortality at 1 month and a higher incidence of Q-wave myocardial infarction and target lesion revascularization-major adverse cardiac events at 6 months compared with non-DM patients. Careful surveillance is required in IDDM patients undergoing SES implantation.

Original languageEnglish
Pages (from-to)1100-1106
Number of pages7
JournalAmerican Journal of Cardiology
Volume96
Issue number8
DOIs
Publication statusPublished - 2005 Oct 15
Externally publishedYes

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Sirolimus
Stents
Coronary Artery Disease
Myocardial Infarction
Therapeutics
Type 1 Diabetes Mellitus
Mortality
Renal Insufficiency
Incidence
Angioplasty
Acute Kidney Injury
Coronary Artery Bypass
Type 2 Diabetes Mellitus
Diabetes Mellitus
Thrombosis
Multivariate Analysis
Obesity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of treatment of coronary artery disease with sirolimus-eluting stents on outcomes of diabetic and nondiabetic patients. / Kuchulakanti, Pramod K.; Torguson, Rebecca; Canos, Daniel; Rha, Seung-Woon; Chu, William W.; Clavijo, Leonardo; Deible, Regina; Gevorkian, Natalie; Suddath, William O.; Satler, Lowell F.; Kent, Kenneth M.; Pichard, Augusto D.; Waksman, Ron.

In: American Journal of Cardiology, Vol. 96, No. 8, 15.10.2005, p. 1100-1106.

Research output: Contribution to journalArticle

Kuchulakanti, PK, Torguson, R, Canos, D, Rha, S-W, Chu, WW, Clavijo, L, Deible, R, Gevorkian, N, Suddath, WO, Satler, LF, Kent, KM, Pichard, AD & Waksman, R 2005, 'Impact of treatment of coronary artery disease with sirolimus-eluting stents on outcomes of diabetic and nondiabetic patients', American Journal of Cardiology, vol. 96, no. 8, pp. 1100-1106. https://doi.org/10.1016/j.amjcard.2005.06.031
Kuchulakanti, Pramod K. ; Torguson, Rebecca ; Canos, Daniel ; Rha, Seung-Woon ; Chu, William W. ; Clavijo, Leonardo ; Deible, Regina ; Gevorkian, Natalie ; Suddath, William O. ; Satler, Lowell F. ; Kent, Kenneth M. ; Pichard, Augusto D. ; Waksman, Ron. / Impact of treatment of coronary artery disease with sirolimus-eluting stents on outcomes of diabetic and nondiabetic patients. In: American Journal of Cardiology. 2005 ; Vol. 96, No. 8. pp. 1100-1106.
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AU - Canos, Daniel

AU - Rha, Seung-Woon

AU - Chu, William W.

AU - Clavijo, Leonardo

AU - Deible, Regina

AU - Gevorkian, Natalie

AU - Suddath, William O.

AU - Satler, Lowell F.

AU - Kent, Kenneth M.

AU - Pichard, Augusto D.

AU - Waksman, Ron

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N2 - Patients with diabetes mellitus are at increased risk for repeat interventions and mortality after coronary angioplasty and stenting. The efficacy of sirolimus-eluting stents (SESs) to improve the outcomes of these patients is a focus of interest. In the first 1,407 patients treated with SESs at our institution, 492 were diabetic (insulin dependent diabetes mellitus [IDDM], n = 160 and non-insulin-dependent DM [NIDDM], n = 332). The in-hospital and 1- and 6-month clinical outcomes were compared with those of 915 patients without DM (non-DM). The baseline characteristics were similar, except for more women, obesity, previous myocardial infarction, coronary artery bypass grafting, and renal insufficiency in the DM group (p <0.001). Compared with non-DM patients, DM patients had higher in-hospital (p <0.05) and 1-month mortality (p = 0.02). IDDM patients had more in-hospital renal failure (p = 0.04) and Q-wave myocardial infarctions (1.6% vs 0%, p = 0.04) compared with NIDDM patients, and higher mortality (3.1% vs 0.8%, p = 0.04) and subacute stent thromboses (2.3% vs 0.5%, p = 0.07) than non-DM patients at 30 days. At 6 months, DM patients had a higher incidence of Q-wave myocardial infarction, target lesion revascularization-major adverse cardiac events, and composite of death and Q-wave myocardial infarction than non-DM patients (6.0% vs 2.7%, p = 0.01). Late outcomes between the IDDM and NIDDM groups were similar. Multivariate analysis showed diabetes and acute renal failure as independent predictors of target lesion revascularization-major adverse cardiac events. In conclusion, our data showed that, despite a reduction in repeat revascularization, coronary intervention with SESs in diabetic patients is limited by higher mortality at 1 month and a higher incidence of Q-wave myocardial infarction and target lesion revascularization-major adverse cardiac events at 6 months compared with non-DM patients. Careful surveillance is required in IDDM patients undergoing SES implantation.

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