1. Diabetes mellitus in patients undergoing percutaneous drug-eluting stent implantation: short and long-term results
Claudio Moretti, M.D.
Division of Cardiology, University of Turin, Turin, Italy
on behalf of the University of Turin Registry Investigators:
G. Longo, F. D’Ascenzo, A. Gonella, A. Pullara, G. Biondi Zoccai, F. Sciuto, P.L. Omedè, G. P. Trevi, I. Sheiban

2. Background
The introduction of drug-eluting stents (DES) has markedly
improved mid-term results of percutaneous coronary
intervention (PCI) in diabetics.
Furthermore it is unclear whether the risk-benefit balance
of DES in diabetics is maintained also at long-term and in insulin requiring patients.
We aimed to appraise long-term outcomes of diabetic
patients treated with PCI with DES, stratifying according to
insulin therapy.

3. Methods
Patients undergoing PCI with DES from July 2002 to June 2004 at our center, and thus eligible for at least 5-year follow-up
N=1277
insulin-requiring diabetics
37/1277 (3%)
without diabetes
954/1277 (75%)
non-insulin-requiring diabetics
275/1277 (22%)

4. Methods
The primary end-point was the long-term rate of major
adverse cardiac events (MACE, ie the composite of death,
myocardial infarction, or target vessel revascularization).
Secondary end-points were the individual components of MACE, as well as death divided according to its etiology.
We also considered stent thrombosis according to the
Academic Research Consortium definitions.

5. Clinical characteristics of patients
30%
81%
34%
75%
54%
32%
There were significant differences across groups in prevalence of male gender (respectively, 32%, 81% and 75%, p<0.001), and DES usage (54%, 34% and 30%, p=0.007).

6. Age of patients
The mean age of patients is comparable in the three groups.

7. Early clinical outcomes
30-day MACE occurred with similar frequency in the three groups (8%, 7% and 6%, p=0.78), with death in 3%, 2%, and 1% (p=0.71) and myocardial infarction in 5%, 2% and 1% (p=0.02).

8. INSULIN-REQUIRING DIABETICS NON-INSULIN-REQUIRING DIABETICS
30-DAY OUTCOMES
INSULIN-REQUIRING DIABETICS
NON-INSULIN-REQUIRING DIABETICS
WITHOUT DIABETICS P
MACE
3/37 (8,.1%)
20/275 (7.3%)
60/954 (6.3%)
0.78
Death
1/37 (2.7%)
5/275 (1.8%)
13/954 (1.4%)
0.71
Sudden death
0/37 (0%)
1/275 (0.4%)
5/954 (0.5%)
086
Non-sudded ischemic death
3/275 (1.1%)
7/954 (0.7%)
Non-ischemic cardiac death
0/275 (0%)
0/954 (0%)
<0.001
Non-cardiac vascular death
Non-cardiovascular death
0.16
Myocardial infarction
2/37 (5.4%)
8/954 (0.8%)
0.02
non Q
2/275 (0.7%)
0.25 Q
2/954 (0.2%)
0.85
Repeat PCI
10/275 (3.6%)
43/954 (4.5%)
CABG
Stroke
4/954 (0.4%)
0.51
Stent thrombosis
9/954 (0.9%)
0.31
Definite
Probable
Possible

9. 30- days outcomes: causes of death

10. Late clinical outcomes
After a median follow-up period of 58 months, MACE occurred in 59% of patients with insulin-requiring diabetes, in 51% of non-insulin-requiring diabetics, and in 39% of non-diabetics (p<0.001), with death in 24%, 17% and 9% (p<0.001), myocardial infarction in 11%, 7%, and 5% (p=0.25), repeat revascularization in 46%, 32%, and 30% (p=0.11), and definite stent thrombosis occurred in in 0%, 1%, and 1% (p=0.78).

11. <0.001 0.001 0.034 LATE CLINICAL OUTCOMES MACE Death Sudden death
INSULIN-REQUIRING DIABETICS
NON-INSULIN-REQUIRING DIABETICS
WITHOUT DIABETICS P
MACE
22/37 (59.5%)
139/275 (50.6%)
371/954 (38.9%)
<0.001
Death
9/37 (24.3%)
48/275 (17.5%)
81/954 (8.5%)
Sudden death
1/37 (2.3%)
10/275 (3.6%)
18/954 (1.9%)
0.229
Non-sudden ischemic death
0/37 (0%)
9/275 (3.3%)
17/954 (1.8%)
0,206
Non-ischemic cardiac death
2/37 (5.4%)
11/954 (1.5%)
Non-cardiac vascular death
2/275 (0.7%)
10/954 (1.1%)
0.74
Non-cardiovascular death
5/37 (13.5%)
16/275 (5.8%)
35/954 (3.7%)
0.007
Myocardial infarction
4/37 (10.8%)
18/275 (6.6%)
49/954 (5.1%)
0.25
non Q
1/37 (2.7%)
27/954 (2.8%)
0.93 Q
6/275 (2.2%)
2/954 (0.2%)
0.001
Repeat PCI
17/37 (45.9%)
87/275 (31.6%)
285/954 (29.7%)
0.12
CABG
16/954 (1.7%)
Stroke
0/37 (2.7%)
5/275 (1.8%)
25/954 (2.6%)
0.47
Stent thrombosis
1/37 (0%)
16/954 (1.6%)
0.79
Definite
3/275 (1.1%)
12/954 (1.2%)
0.78
Probable
0.034
Possible
1/275 (0.4%)
0.86

12. Late clinical outcomes: causes of death

13. Conclusions
This long-term retrospective study emphasizes the very
high risk of long-term adverse events faced by insulin
requiring and non-insulin-requiring diabetics undergoing
PCI with DES.
Further research on additional pharmacologic treatments or hybrid revascularization strategies to mitigate their burden of morbidity and mortality is warranted.

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