IMPACT OF DIABETES-MELLITUS ON PERCUTANEOUS REVASCULARIZATION (CAVEAT-I)

We examined the relation between diabetes mellitus and outcomes in pat ients undergoing percutaneous coronary revascularization in the Corona ry Angioplasty Versus Excisional Atherectomy Trial (CAVEAT-I), a rando mized trial comparing treatment with either percutaneous transluminal coronary angioplasty or directional atherectomy for de novo lesions in native coronary arteries. Acute success and complication rates, 6-mon th angiographic restenosis rates, and I-year clinical outcomes were co mpared between diabetic and nondiabetic patients undergoing each proce dure, Acute success rates between diabetic (n = 191) and nondiabetic ( n = 821) patients were similar for both revascularization techniques. Except for the need for dialysis, complication rates were also similar , Six months after atherectomy, diabetic patients had significantly mo re angiographic restenosis than nondiabetics (59.7% vs 47.4%) and sign ificantly smaller minimum luminal diameters (1.20 vs 1.40 mm). Diabeti cs undergoing atherectomy required more frequent bypass surgery (12.8% vs 8.5%) and more repeat percutaneous revascularizations (36.5% vs 28 .1%) than nondiabetics undergoing atherectomy. Restenosis rates, minim um luminal diameters and repeat revascularizations between diabetics a nd nondiabetics undergoing angioplasty were similar, The higher resten osis and repeat revascularization rates and the smaller minimum lumina l diameter at follow-up in diabetic patients suggest that atherectomy may provide only modest benefit for these patients. The increased rest enosis rate in diabetics undergoing atherectomy (but not angioplasty) requires further evaluation. (C) 1997 by Excerpta Medica, Inc.