Impact of Diabetes Mellitus on Early and Long-term Results of Percutaneous Drug- eluting Stent Implantation for Unprotected Left Main Coronary Disease

Impact of Diabetes Mellitus on Impact of Diabetes Mellitus on

Early and Long-term Results of Early and Long-term Results of

Percutaneous Drug-eluting Stent Percutaneous Drug-eluting Stent

Implantation for Unprotected Left Implantation for Unprotected Left

Main Coronary DiseaseMain Coronary Disease

Paolo Garrone, Dario Sillano, Primiano Paolo Garrone, Dario Sillano, Primiano Lombardi, Claudio Moretti, Lombardi, Claudio Moretti, Filippo SciutoFilippo Sciuto, , Pierluigi Omedè, Giuseppe Biondi-Zoccai, Pierluigi Omedè, Giuseppe Biondi-Zoccai,

Gian Paolo Trevi, Imad SheibanGian Paolo Trevi, Imad Sheiban

Division of Cardiology, University of Turin, Division of Cardiology, University of Turin, ItalyItaly

BACKGROUNDBACKGROUND

Percutaneous coronary intervention Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) (PCI) with drug-eluting stent (DES) implantation is increasingly used for implantation is increasingly used for unprotected left mainunprotected left main disease (ULM) disease (ULM)

Drug-eluting stent implantation Drug-eluting stent implantation favorably influences outcome in favorably influences outcome in diabetic patientsdiabetic patients with non-ULM with non-ULM

There are no data on the clinical There are no data on the clinical results of DES for ULM in diabetic results of DES for ULM in diabetic patientspatients

AIM OF THE STUDYAIM OF THE STUDY

We aimed to appraise the We aimed to appraise the outcomes of diabetics with outcomes of diabetics with unprotected left main disease unprotected left main disease (ULM) treated with drug-eluting (ULM) treated with drug-eluting stents (DES)stents (DES)

METHODSMETHODS

We abstracted baseline, procedural We abstracted baseline, procedural and follow-up data on all patients and follow-up data on all patients

undergoing PCI for undergoing PCI for ULMULM disease at disease at our Institution our Institution

treated with treated with DESDES since 2002 since 2002 andand identified 3 groups according to identified 3 groups according to

their their diabetic statusdiabetic status

END-POINTEND-POINT

We evaluate the rate of We evaluate the rate of major adverse major adverse cardiac eventscardiac events (MACE) defined as: (MACE) defined as:

cardiac death, cardiac death, myocardial infarction, myocardial infarction, or target vessel revascularizationor target vessel revascularization

Secondary end-points were individual Secondary end-points were individual MACE components and stent MACE components and stent thrombosis (according to ARC)thrombosis (according to ARC)

RESULTSRESULTS

A total of 185 patients were enrolled

insulin-dependent diabetics

IDD

25/185 (14%)

non-insulin-dependent diabetics

NIDD

30/185 (16%)

non-diabetics ND

130/185 (70%)

RESULTSRESULTSIDDM NIDDM NDM p

(n=25) (n=30) (n=130)

Età (anni) 68±8 72±10 68±11 0.18

Maschi 10 (40%) 23 (76%) 116 (89%) <0.01

Ipertensione 21 (84%) 26 (87%) 119 (92%) 0.44

Dislipidemia 19 (76%) 21 (70%) 102 (78%) 0.61

Fumatore attuale 1 (4%) 3 (10%) 18 (14%) 0.37

Ex fumatore 7 (28%) 4 (13%) 43 (33%) 0.10

Pregresso infarto miocardico 14 (56%) 8 (27%) 55 (42%) 0.09

Pregresso infarto miocardico non Q 9 (36%) 7 (23%) 32 (25%) 0.46

Infarto miocardico recente 4 (16%) 3 (10%) 14 (11%) 0.73

Pregressa rivascolarizzazione cardiaca percutanea 6 (24%) 4 (13%) 41 (32%) 0.12

Pregresso by-pass aorto-coronarico 2 (8%) 2 (7%) 13 (10%) 0.83

Pregresso ictus 0 (0%) 0 (0%) 2 (2%) 0.65

Pregressa ipertensione polmonare 1 (4%) 2 (7%) 5 (4%) 0.79

Presenza di insufficienza mitralica 8 (32%) 9 (30%) 35 (27%) 0.85

Frazione di eiezione ventricolo sinistro 51±10 53±10 53±11 0.71

Insufficienza renale 2 (8%) 0 (0%) 3 (2%) 0.17

RESULTSRESULTS

In-hospitalIn-hospital adverse events were adverse events were uncommon and not significantly uncommon and not significantly different across groups: 1/25 (4%), different across groups: 1/25 (4%), 2/30 (7%), and 8/130 (6%) (p=0.86). 2/30 (7%), and 8/130 (6%) (p=0.86).

After a median After a median follow-upfollow-up of 23.1 of 23.1 months, MACE had occurred in months, MACE had occurred in similar rates across groups...similar rates across groups...

RESULTSRESULTSIDD NIDD Total DM ND P

MACE 6/25 (24%) 8/30 (27%) 14/55 (25%) 31/128 (24%) 0.96

Non-cardiac death 0/25 (0%) 3/30 (10%) 3/55 (5%) 0/129 (3%) <0.001

Cardiac Death 4/25 (16%) 1/30 (3%) 5/55 (9%) 4/129 (3%) 0.02

AMI 2/25 (8%) 1/30 (3%) 3/55 (5%) 13/128 (10%) 0.49

Re-PTCA ULM 2/25 (8%) 6/30 (20%) 8/55 (15%) 14/128 (11%) 0.31

CABG 0/25 (0%) 0/30 (0%) 0/55 (0%) 5/128 (4%) 0.33

Transplant 0/25 (0%) 0/30 (0%) 0/55 (0%) 1/128 (0.8%) 0.81

Ictus 0/25 (0%) 0/30 (0%) 0/55 (0%) 2/128 (2%) 0.65

Stent Thrombosis

Definite 0/25 (0%) 0/30 (0%) 0/55 (0%) 0/128 (0%) 1

Probable 1/25 (4%) 0/30 (0%) 1/55 (2%) 6/128 (5%) 0.48

Possible 3/25 (12%) 0/30 (0%) 3/55 (5%) 2/128 (2%) 0.008

RePTCA non-ULM 5/25 (20%) 10/30 (33%) 15/55 (27%) 40/128 (31%) 0.49


MACE 6/25 (24%) 8/30 (27%) 14/55 (25%) 31/128 (24%) 0.96


Cardiac Death 4/25 (16%) 1/30 (3%) 5/55 (9%) 4/129 (3%) 0.02

AMI 2/25 (8%) 1/30 (3%) 3/55 (5%) 13/128 (10%) 0.49

Re-PTCA ULM 2/25 (8%) 6/30 (20%) 8/55 (15%) 14/128 (11%) 0.31

CABG 0/25 (0%) 0/30 (0%) 0/55 (0%) 5/128 (4%) 0.33

Transplant 0/25 (0%) 0/30 (0%) 0/55 (0%) 1/128 (0.8%) 0.81

Ictus 0/25 (0%) 0/30 (0%) 0/55 (0%) 2/128 (2%) 0.65

Stent Thrombosis

Definite 0/25 (0%) 0/30 (0%) 0/55 (0%) 0/128 (0%) 1

Probable 1/25 (4%) 0/30 (0%) 1/55 (2%) 6/128 (5%) 0.48

Possible 3/25 (12%) 0/30 (0%) 3/55 (5%) 2/128 (2%) 0.008

RePTCA non-ULM 5/25 (20%) 10/30 (33%) 15/55 (27%) 40/128 (31%) 0.49

0%10%20%30%40%50%60%70%80%90%

100%

IDDNIDDND


MACE 6/25 (24%) 8/30 (27%) 14/55 (25%) 31/128 (24%) 0.96


Cardiac Death 4/25 (16%) 1/30 (3%) 5/55 (9%) 4/129 (3%) 0.02

AMI 2/25 (8%) 1/30 (3%) 3/55 (5%) 13/128 (10%) 0.49

Re-PTCA ULM 2/25 (8%) 6/30 (20%) 8/55 (15%) 14/128 (11%) 0.31

CABG 0/25 (0%) 0/30 (0%) 0/55 (0%) 5/128 (4%) 0.33

Transplant 0/25 (0%) 0/30 (0%) 0/55 (0%) 1/128 (0.8%) 0.81

Ictus 0/25 (0%) 0/30 (0%) 0/55 (0%) 2/128 (2%) 0.65

Stent Thrombosis

Definite 0/25 (0%) 0/30 (0%) 0/55 (0%) 0/128 (0%) 1

Probable 1/25 (4%) 0/30 (0%) 1/55 (2%) 6/128 (5%) 0.48

Possible 3/25 (12%) 0/30 (0%) 3/55 (5%) 2/128 (2%) 0.008

RePTCA non-ULM 5/25 (20%) 10/30 (33%) 15/55 (27%) 40/128 (31%) 0.49


MACE 6/25 (24%) 8/30 (27%) 14/55 (25%) 31/128 (24%) 0.96


Cardiac Death 4/25 (16%) 1/30 (3%) 5/55 (9%) 4/129 (3%) 0.02

AMI 2/25 (8%) 1/30 (3%) 3/55 (5%) 13/128 (10%) 0.49

Re-PTCA ULM 2/25 (8%) 6/30 (20%) 8/55 (15%) 14/128 (11%) 0.31

CABG 0/25 (0%) 0/30 (0%) 0/55 (0%) 5/128 (4%) 0.33

Transplant 0/25 (0%) 0/30 (0%) 0/55 (0%) 1/128 (0.8%) 0.81

Ictus 0/25 (0%) 0/30 (0%) 0/55 (0%) 2/128 (2%) 0.65

Stent Thrombosis

Definite 0/25 (0%) 0/30 (0%) 0/55 (0%) 0/128 (0%) 1

Probable 1/25 (4%) 0/30 (0%) 1/55 (2%) 6/128 (5%) 0.48

Possible 3/25 (12%) 0/30 (0%) 3/55 (5%) 2/128 (2%) 0.008

RePTCA non-ULM 5/25 (20%) 10/30 (33%) 15/55 (27%) 40/128 (31%) 0.49

MACE-free survivalMACE-free survival

Non-diabetics

NIDD

IDD

12009006003000

1,0

,8

,6

,4

,2

0,0

Time (days)

MA

CE

-fre

e su

rviv

al

P=0.88

CONCLUSIONCONCLUSION

Drug-eluting stents provide Drug-eluting stents provide favorable favorable early and long-term resultsearly and long-term results in both in both diabetics and non-diabetic patients diabetics and non-diabetic patients undergoing PCI for ULM. undergoing PCI for ULM.

Given the possible increased risk of Given the possible increased risk of thrombosis among insulin-dependent-thrombosis among insulin-dependent-diabetics, these patients should diabetics, these patients should probably be treated with dual probably be treated with dual antiplatelet therapy for a more antiplatelet therapy for a more prolonged time.prolonged time.

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Impact of Diabetes Mellitus on Early and Long-term Results of Percutaneous Drug- eluting Stent Implantation for Unprotected Left Main Coronary Disease