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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.

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Presentation on theme: "Impact of Diabetes Mellitus on Early and Long-term Results of Percutaneous Drug- eluting Stent Implantation for Unprotected Left Main Coronary Disease."— Presentation transcript:

1 Impact of Diabetes Mellitus on Early and Long-term Results of Percutaneous Drug- eluting Stent Implantation for Unprotected Left Main Coronary Disease Paolo Garrone, Dario Sillano, Primiano Lombardi, Claudio Moretti, Filippo Sciuto, Pierluigi Omedè, Giuseppe Biondi- Zoccai, Gian Paolo Trevi, Imad Sheiban Division of Cardiology, University of Turin, Italy

2 BACKGROUND Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is increasingly used for unprotected left main disease (ULM) Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is increasingly used for unprotected left main disease (ULM) Drug-eluting stent implantation favorably influences outcome in diabetic patients with non-ULM Drug-eluting stent implantation favorably influences outcome in diabetic patients with non-ULM There are no data on the clinical results of DES for ULM in diabetic patients There are no data on the clinical results of DES for ULM in diabetic patients

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

4 METHODS We abstracted baseline, procedural and follow-up data on all patients undergoing PCI for ULM disease at our Institution undergoing PCI for ULM disease at our Institution treated with DES treated with DES since 2002 and since 2002 and identified 3 groups according to their diabetic status identified 3 groups according to their diabetic status

5 END-POINT We evaluate the rate of major adverse cardiac events (MACE) defined as: cardiac death, cardiac death, myocardial infarction, myocardial infarction, or target vessel revascularization or target vessel revascularization Secondary end-points were individual MACE components and stent thrombosis (according to ARC)

6 RESULTS 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%)

7 RESULTS IDDMNIDDMNDMp (n=25)(n=30)(n=130) Età (anni)68±872±1068±110.18 Maschi10 (40%)23 (76%)116 (89%)<0.01 Ipertensione21 (84%)26 (87%)119 (92%)0.44 Dislipidemia19 (76%)21 (70%)102 (78%)0.61 Fumatore attuale1 (4%)3 (10%)18 (14%)0.37 Ex fumatore7 (28%)4 (13%)43 (33%)0.10 Pregresso infarto miocardico14 (56%)8 (27%)55 (42%)0.09 Pregresso infarto miocardico non Q9 (36%)7 (23%)32 (25%)0.46 Infarto miocardico recente4 (16%)3 (10%)14 (11%)0.73 Pregressa rivascolarizzazione cardiaca percutanea6 (24%)4 (13%)41 (32%)0.12 Pregresso by-pass aorto-coronarico2 (8%)2 (7%)13 (10%)0.83 Pregresso ictus0 (0%) 2 (2%)0.65 Pregressa ipertensione polmonare1 (4%)2 (7%)5 (4%)0.79 Presenza di insufficienza mitralica8 (32%)9 (30%)35 (27%)0.85 Frazione di eiezione ventricolo sinistro51±1053±1053±110.71 Insufficienza renale2 (8%)0 (0%)3 (2%)0.17

8 RESULTS In-hospital adverse events were uncommon and not significantly different across groups: 1/25 (4%), 2/30 (7%), and 8/130 (6%) (p=0.86). In-hospital adverse events were uncommon and not significantly different across groups: 1/25 (4%), 2/30 (7%), and 8/130 (6%) (p=0.86). After a median follow-up of 23.1 months, MACE had occurred in similar rates across groups... After a median follow-up of 23.1 months, MACE had occurred in similar rates across groups...

9 RESULTS IDDNIDDTotal DMNDP MACE6/25 (24%)8/30 (27%)14/55 (25%)31/128 (24%)0.96 Non-cardiac death0/25 (0%)3/30 (10%)3/55 (5%)0/129 (3%)<0.001 Cardiac Death4/25 (16%)1/30 (3%)5/55 (9%)4/129 (3%)0.02 AMI2/25 (8%)1/30 (3%)3/55 (5%)13/128 (10%)0.49 Re-PTCA ULM2/25 (8%)6/30 (20%)8/55 (15%)14/128 (11%)0.31 CABG0/25 (0%)0/30 (0%)0/55 (0%)5/128 (4%)0.33 Transplant0/25 (0%)0/30 (0%)0/55 (0%)1/128 (0.8%)0.81 Ictus0/25 (0%)0/30 (0%)0/55 (0%)2/128 (2%)0.65 Stent Thrombosis Definite0/25 (0%)0/30 (0%)0/55 (0%)0/128 (0%)1 Probable1/25 (4%)0/30 (0%)1/55 (2%)6/128 (5%)0.48 Possible3/25 (12%)0/30 (0%)3/55 (5%)2/128 (2%)0.008 RePTCA non-ULM5/25 (20%)10/30 (33%)15/55 (27%)40/128 (31%)0.49

10 RESULTS IDDNIDDTotal DMNDP MACE6/25 (24%)8/30 (27%)14/55 (25%)31/128 (24%)0.96 Non-cardiac death0/25 (0%)3/30 (10%)3/55 (5%)0/129 (3%)<0.001 Cardiac Death4/25 (16%)1/30 (3%)5/55 (9%)4/129 (3%)0.02 AMI2/25 (8%)1/30 (3%)3/55 (5%)13/128 (10%)0.49 Re-PTCA ULM2/25 (8%)6/30 (20%)8/55 (15%)14/128 (11%)0.31 CABG0/25 (0%)0/30 (0%)0/55 (0%)5/128 (4%)0.33 Transplant0/25 (0%)0/30 (0%)0/55 (0%)1/128 (0.8%)0.81 Ictus0/25 (0%)0/30 (0%)0/55 (0%)2/128 (2%)0.65 Stent Thrombosis Definite0/25 (0%)0/30 (0%)0/55 (0%)0/128 (0%)1 Probable1/25 (4%)0/30 (0%)1/55 (2%)6/128 (5%)0.48 Possible3/25 (12%)0/30 (0%)3/55 (5%)2/128 (2%)0.008 RePTCA non-ULM5/25 (20%)10/30 (33%)15/55 (27%)40/128 (31%)0.49

11 RESULTS IDDNIDDTotal DMNDP MACE6/25 (24%)8/30 (27%)14/55 (25%)31/128 (24%)0.96 Non-cardiac death0/25 (0%)3/30 (10%)3/55 (5%)0/129 (3%)<0.001 Cardiac Death4/25 (16%)1/30 (3%)5/55 (9%)4/129 (3%)0.02 AMI2/25 (8%)1/30 (3%)3/55 (5%)13/128 (10%)0.49 Re-PTCA ULM2/25 (8%)6/30 (20%)8/55 (15%)14/128 (11%)0.31 CABG0/25 (0%)0/30 (0%)0/55 (0%)5/128 (4%)0.33 Transplant0/25 (0%)0/30 (0%)0/55 (0%)1/128 (0.8%)0.81 Ictus0/25 (0%)0/30 (0%)0/55 (0%)2/128 (2%)0.65 Stent Thrombosis Definite0/25 (0%)0/30 (0%)0/55 (0%)0/128 (0%)1 Probable1/25 (4%)0/30 (0%)1/55 (2%)6/128 (5%)0.48 Possible3/25 (12%)0/30 (0%)3/55 (5%)2/128 (2%)0.008 RePTCA non-ULM5/25 (20%)10/30 (33%)15/55 (27%)40/128 (31%)0.49

12 RESULTS IDDNIDDTotal DMNDP MACE6/25 (24%)8/30 (27%)14/55 (25%)31/128 (24%)0.96 Non-cardiac death0/25 (0%)3/30 (10%)3/55 (5%)0/129 (3%)<0.001 Cardiac Death4/25 (16%)1/30 (3%)5/55 (9%)4/129 (3%)0.02 AMI2/25 (8%)1/30 (3%)3/55 (5%)13/128 (10%)0.49 Re-PTCA ULM2/25 (8%)6/30 (20%)8/55 (15%)14/128 (11%)0.31 CABG0/25 (0%)0/30 (0%)0/55 (0%)5/128 (4%)0.33 Transplant0/25 (0%)0/30 (0%)0/55 (0%)1/128 (0.8%)0.81 Ictus0/25 (0%)0/30 (0%)0/55 (0%)2/128 (2%)0.65 Stent Thrombosis Definite0/25 (0%)0/30 (0%)0/55 (0%)0/128 (0%)1 Probable1/25 (4%)0/30 (0%)1/55 (2%)6/128 (5%)0.48 Possible3/25 (12%)0/30 (0%)3/55 (5%)2/128 (2%)0.008 RePTCA non-ULM5/25 (20%)10/30 (33%)15/55 (27%)40/128 (31%)0.49

13 MACE-free survival Non-diabetics NIDD IDD Time (days) MACE-free survival P=0.88

14 CONCLUSION Drug-eluting stents provide favorable early and long-term results in both diabetics and non- diabetic patients undergoing PCI for ULM. Drug-eluting stents provide favorable early and long-term results in both diabetics and non- diabetic patients undergoing PCI for ULM. Given the possible increased risk of thrombosis among insulin-dependent-diabetics, these patients should probably be treated with dual antiplatelet therapy for a more prolonged time. Given the possible increased risk of thrombosis among insulin-dependent-diabetics, these patients should probably be treated with dual antiplatelet therapy for a more prolonged time.

15 For further slides on these topics please feel free to visit the metcardio.org website: http://www.metcardio.org/slides.html http://www.metcardio.org/slides.html

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