Multivessel drug-eluting stenting and impact of diabetes mellitus--a report from the EVENT registry.
OBJECTIVES: To compare clinical outcomes in patients with and without diabetes after multivessel percutaneous coronary intervention (PCI). BACKGROUND: Diabetes is associated with significantly worse outcomes after multivessel PCI and coronary bypass surgery is recommended as the preferred option for these patients. METHODS AND RESULTS: The Evaluation of Drug Eluting Stents and Ischemic Events registry is a multicenter evaluation of acute and 1 year outcomes in unselected patients undergoing PCI since approval of drug-eluting stents (DES). Major adverse cardiac events (MACE) were defined as all cause mortality, myocardial infarction, or repeat revascularization and rate was estimated by Kaplan-Meier method and compared using log-rank. The independent correlates of MACE were determined using Cox proportional hazards regression. Of 4,819 nonemergency native coronary DES procedures, 1,595 (33.1%) were in patients with diabetes and 722 (11.7%) involved >1 vessel. Of patients undergoing multivessel procedures, diabetes was present in 256 (35.5%). One year after multivessel PCI, MACE was similar for patients with or without diabetes (22.3% versus 21.2%, log-rank test P = 0.85). The independent correlates of 1 year MACE were female sex (Hazard ratio [HR], 1.58, 95% CI 1.14-2.20), ejection fraction (HR 0.74 per group [<25%, 26-35%, 36-50%, and >50%], 95%CI 0.59-0.94) and number of stents (HR 1.20 per stent, 95%CI 1.04-1.38) but not diabetes (HR 1.00, 95% CI 0.71-1.39). CONCLUSIONS: Multivessel DES is performed commonly in patients with diabetes with outcomes at 1 year similar to patients without diabetes. Longer follow-up is required to more fully evaluate the safety and effectiveness of this strategy.
Novack, V; Tsyvine, D; Cohen, DJ; Pencina, M; Dubin, J; Dehghani, H; Kleiman, NS; Cutlip, DE
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