Long-term clinical outcomes of drug-eluting stents in diabetic patients with small vessels compared to larger vessel-7 years clinical follow-up

Walid Hassan; Khaled Tammam; Manzoor Memon; Shabir Shah; Mohammed Mostafa; Mohamed Shoukri

doi:10.1016/j.carrev.2015.05.012

Long-term clinical outcomes of drug-eluting stents in diabetic patients with small vessels compared to larger vessel-7 years clinical follow-up

Cardiovasc Revasc Med. 2015 Sep;16(6):336-9. doi: 10.1016/j.carrev.2015.05.012. Epub 2015 Jun 3.

Authors

Walid Hassan¹, Khaled Tammam², Manzoor Memon³, Shabir Shah³, Mohammed Mostafa², Mohamed Shoukri³

Affiliations

¹ Cardiac Center of Excellence, International Medical Center, Jeddah, Saudi Arabia. Electronic address: hassan_walid@hotmail.com.
² Cardiac Center of Excellence, International Medical Center, Jeddah, Saudi Arabia.
³ King Faisal Heart Institute, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

PMID: 26112295
DOI: 10.1016/j.carrev.2015.05.012

Abstract

Objectives: The aim of this study was to analyze the effectiveness of drug-eluting stents (DES) in small vessels in patients with non-insulin-dependent (NIDDM) and insulin-dependent diabetes mellitus (IDDM).

Background: Several randomized trials have shown DES to significantly reduce the angiographic and clinical events in diabetic patients. However, there is insufficient data on similar outcomes in diabetics with small vessels.

Methods: We studied 258 consecutive diabetic patients (173 NIDDM and 85 IDDM) who underwent coronary stenting with DES, divided into 2 cohorts: group A (vessels<2.7mm): 163 patients, and group B (vessels≥2.7mm): 95 patients. We analyzed the major adverse cardiac events (MACE) [death, nonfatal myocardial infarction MI, and target lesion revascularization (TVR)] over a mean follow-up of 78.4±14.8months.

Results: Group A patients had: smaller reference diameter (2.4±0.31 versus 3.14±0.2mm, p=0.0001), longer lesions (19.3±9.5 versus 16.7±7.1mm, p=0.023), more complex lesions: (B2/C) (80.7 versus 52.6%, p<0.033), bifurcation lesions (25.8 versus 11.6%, p=0.007), diffuse disease (42.9 versus 26.3%, p=0.008), multivessel (32.5 versus 18.9%, p=0.019), eccentric lesions (57.1 versus 43.2%, p=0.031), more stents implanted (1.99±1.6 versus 1.7±1.3, p<0.0001), more overlapping stents (29.4 versus 13.7%, p=0.004) and more stents length (25.7±4.9 versus 20.2±2.6, p<0.003). During the follow-up, both groups had overall similar MACE (10.4 versus 11.7%, p=0.9) with insignificant higher restenosis (9.2 versus 8.4%, p=0.832) and TVR (7.4 versus 6.4%, p=0.75) in group A. There was no difference in death (p=0.111) or MI (p=0.858). Both groups had similar stent thrombosis rate (1.2 versus 1.1%, p=0.899), angina events (10.4 versus 16.8%, p=0.137), abnormal stress thallium (14.1 versus 14.7%, p=0.890), and hospital days (2.91 versus 3.57, p=0.886).

Conclusion: Despite complex angiographic characteristics, the use of DES in diabetic patients with small vessels showed favorable clinical outcomes and similar low TVR compared to those with large vessels.

Keywords: Diabetic; Drug-eluting stent; Outcomes; Small vessel.

MeSH terms

Comorbidity
Coronary Angiography
Coronary Stenosis / diagnostic imaging
Coronary Stenosis / epidemiology*
Coronary Stenosis / therapy*
Diabetes Mellitus / epidemiology*
Drug-Eluting Stents*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Risk Factors
Treatment Outcome