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Published on: May 14, 2013
Diabetes-related ten-year outcomes after percutaneous coronary intervention of in-stent restenosis
Constantin Kuna1, Eduard Braun2, Christian Bradaric3
1Department of Cardiology, Deutsches Herzzentrum München, Universitätsklinikum Der Technischen Universität München, Munich, Germany. kuna@dhm.mhn.de.
Insights
Diabetics undergoing percutaneous coronary intervention for drug-eluting stent in-stent restenosis face significantly higher long-term risks of cardiac death, myocardial infarction, and repeat revascularization compared to non-diabetics.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diabetes Mellitus
Background:
- Limited long-term outcome data exists for diabetic patients after percutaneous coronary intervention (PCI) of coronary drug-eluting stent (DES) in-stent restenosis (ISR).
- This study addresses the evidence gap regarding long-term outcomes in this specific patient population.
Purpose of the Study:
- To evaluate the long-term outcomes of percutaneous coronary intervention (PCI) for drug-eluting stent (DES) in-stent restenosis (ISR) in diabetic patients.
- To compare these outcomes with those of non-diabetic patients.
Main Methods:
- Observational, retrospective study of 3511 patients with 5497 ISR lesions treated between January 2007 and February 2021.
- Analysis included rates of cardiac death, myocardial infarction (MI), and repeat revascularization.
- Kaplan-Meier survival analysis and multivariable analysis were performed.
Main Results:
- Diabetics had significantly higher rates of cardiac death (42.8% vs. 32.8%) and MI (15.9% vs. 9.7%) after 10 years.
- Repeat revascularization rates were also significantly higher in diabetics.
- Insulin-dependent diabetics showed higher cardiac death and MI rates than non-insulin-dependent diabetics.
Conclusions:
- Long-term outcomes after PCI of DES-ISR are significantly worse for diabetic patients compared to non-diabetics.
- Diabetics, especially those insulin-dependent, experience higher rates of cardiac death, MI, and repeat revascularization.
Background:
Limited data is available for long-term outcomes after percutaneous coronary intervention (PCI) of coronary drug-eluting stent (DES) in-stent restenosis (ISR) in diabetics.
Aims:
Thus, the aim of this observational, retrospective study was to close this lack of evidence.
Methods:
Between January 2007 and February 2021, a total of 3511 patients with 5497 ISR lesions were treated at two large-volume centers in Munich, Germany, of which 1242 (35.4%) were diabetics. Endpoints of interest were the rates of cardiac death, repeat revascularization, and myocardial infarction (MI). Survival was analyzed using the Kaplan-Meier method. Differences between the groups were tested with the log-rank test. Conventional multivariable analysis with adjustment for relevant variables was performed.
Results:
After 10 years, the rates of cardiac death were 42.8% for diabetics and 32.8% for nondiabetics (HRadj 1.55 [95% CI, 1.31-1.81], p < 0.001). MI occurred in 15.9% of diabetics and in 9.7% of non-diabetics (HRadj 1.70 [95% CI, 1.36-2.11], p < 0.001). The rates of repeat revascularization of target lesion (HRadj 1.17 [95% CI, 1.02-1.34], p = 0.028), target vessel, and nontarget vessel were significantly higher in diabetics as compared to nondiabetics. No statistically relevant difference was found regarding the rate of stent thrombosis. Compared to non-insulin-dependent diabetics, insulin-dependent diabetics show higher rates of cardiac death and MI, but comparable revascularization rates in both diabetic groups.
Conclusions:
In the long term, the rates of cardiac death, MI, and repeat revascularization after PCI of DES-ISR are significantly higher in diabetics, particularly in insulin-dependent diabetics, than in nondiabetics.
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