Impact of Diabetes Mellitus on Early and
Long-term Results of Percutaneous Drugeluting Stent Implantation for Unprotected
Left Main Coronary Disease
Paolo Garrone, Dario Sillano, Primiano Lombardi, Claudio
Moretti, Filippo Sciuto, Pierluigi Omedè, Giuseppe BiondiZoccai, Gian Paolo Trevi, Imad Sheiban
Division of Cardiology, University of Turin, Italy
BACKGROUND



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
There are no data on the clinical results of DES
for ULM in diabetic patients
AIM OF THE STUDY
We aimed to appraise the outcomes of
diabetics with unprotected left main
disease (ULM) treated with drug-eluting
stents (DES)
METHODS
We abstracted baseline, procedural and follow-up
data on all patients
 undergoing PCI for ULM disease at our
Institution
 treated with DES
 since 2002 and
 identified 3 groups according to their diabetic
status
END-POINT
We evaluate the rate of major adverse cardiac
events (MACE) defined as:



cardiac death,
myocardial infarction,
or target vessel revascularization
Secondary end-points were individual MACE
components and stent thrombosis (according to
ARC)
RESULTS
A total of
185 patients
were enrolled
insulin-dependent
diabetics
IDD
non-insulin-dependent
diabetics
NIDD
25/185 (14%)
30/185 (16%)
non-diabetics
ND
130/185 (70%)
RESULTS
IDDM
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
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).
After a median follow-up of 23.1 months,
MACE had occurred in similar rates across
groups...
RESULTS
IDD
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
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
Stent Thrombosis
RESULTS
IDD
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
1/30 (3%)
3/55 (5%)
13/128 (10%)
0.49
6/30 (20%)
8/55 (15%)
14/128 (11%)
0.31
0/30 (0%)
0/55 (0%)
5/128 (4%)
0/30 (0%)
0/55 (0%)
0/30 (0%)
0/55 (0%)
IDD
1/128 (0.8%)
NIDD
2/128 (2%)
ND
0.33
0/30 (0%)
0/55 (0%)
0/128 (0%)
1
0/30 (0%)
1/55 (2%)
6/128 (5%)
0.48
100%2/25 (8%)
90%
Re-PTCA ULM
80%2/25 (8%)
70%0/25 (0%)
CABG
60%0/25 (0%)
Transplant
50%
Ictus
40%0/25 (0%)
30%
Stent Thrombosis
20%
Definite
10%0/25 (0%)
0%1/25 (4%)
Probable
AMI
0.81
0.65
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
RESULTS
IDD
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
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
5/25 (20%)
10/30 (33%)
15/55 (27%)
40/128 (31%)
0.49
Stent Thrombosis
RePTCA non-ULM
RESULTS
IDD
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
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
Stent Thrombosis
MACE-free survival
1,0
MACE-free survival
,8
Non-diabetics
NIDD
,6
IDD
,4
,2
P=0.88
0,0
0
300
600
Time (days)
900
1200
CONCLUSION


Drug-eluting stents provide favorable early and
long-term results in both diabetics and nondiabetic 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.
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