ISSN 2996-8215
International Journal of Cardiology | Vol. 1, No. 4, April 2010 | pp. 25–32
DOI: 10.46882/2010/IJC/000013
Original Research Article
Impact of Diabetes Mellitus on Long-Term Outcomes Following Percutaneous Coronary Intervention with Drug-Eluting Stents
Kenji Tanaka¹, Aisha Al-Mansoori², Robert J. Gallagher³
¹Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
²Cardiology Department, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
³Cardiovascular Division, King's College London, London, United Kingdom
Abstract:
Diabetes mellitus (DM) significantly accelerates atherogenesis and worsens clinical outcomes after percutaneous coronary intervention (PCI). This study aimed to evaluate the 5-year clinical outcomes of diabetic patients undergoing PCI with first-generation drug-eluting stents (DES) compared to non-diabetic individuals in a real-world registry. We analyzed data from 1,250 consecutive patients (412 with DM, 838 without DM) who underwent successful DES implantation between 2004 and 2005. The primary endpoint was the 5-year rate of major adverse cardiac events (MACE), defined as a composite of all-cause death, non-fatal myocardial infarction (MI), and target lesion revascularization (TLR). At 5 years, the cumulative incidence of MACE was significantly higher in diabetic patients than in non-diabetic patients (26.5% vs. 15.8%, p < 0.001). This difference was driven by higher rates of both TLR (14.1% vs. 8.2%, p < 0.01) and all-cause mortality (9.7% vs. 5.4%, p = 0.02). Insulin-dependent diabetic patients (n = 134) experienced the highest MACE rate at 34.3%. Multivariable Cox regression analysis identified insulin-treated DM as an independent predictor of 5-year MACE (hazard ratio: 2.12, 95% CI: 1.54–2.92, p < 0.001). Stent thrombosis rates did not differ significantly between the overall diabetic and non-diabetic cohorts (2.4% vs. 1.8%, p = 0.45). Despite the use of drug-eluting stents, patients with diabetes mellitus, particularly those requiring insulin therapy, continue to exhibit substantially higher risks of long-term MACE and target lesion revascularization compared to non-diabetic individuals.
Keywords: Diabetes mellitus, Percutaneous coronary intervention, Drug-eluting stents, Long-term outcomes, Target lesion revascularization
Received: January 08, 2010; Revised: February 22, 2010; Accepted: March 12, 2010; Published: April 18, 2010
Citation: International Journal of Cardiology, 2010, Vol. 1, No. 4, pp. 25–32, DOI: 10.46882/2010/IJC/000013