Diabetes mellitus and the clinical and angiographic outcome after coronarystent placement

Objectives. The objectives of this study were to analyze the clinical and a ngiographic outcome of diabetic patients with successful coronary stent pla cement and to compare these results with those achieved after stenting in n ondiabetic patients. Background. The outcome of diabetic patients treated with stent placement d ue to coronary artery disease has not been assessed comprehensively. Methods. This study analyzes a consecutive series of patients with successf ul stent placement comprising 715 patients with diabetes and 2,839 patients without diabetes. Clinical one year follow-up and angiographic control at 6 months were part of the protocol. Death, myocardial infarction and target lesion revascularization were considered as adverse events. An automated e dge detection system was used for the angiographic assessment. The primary clinical endpoint was event-free survival at one year. The primary angiogra phic endpoint was restenosis rate at 6 months (greater than or equal to 50% diameter stenosis). Results. Event free survival was significantly lower in diabetic than in no ndiabetic patients (73.1 vs. 78.5%, p < 0.001). Survival free of myocardial infarction was also significantly reduced in the diabetic group (89.9 vs. 94.4% in nondiabetics, p < 0.001). The incidence of both restenosis (37.5 v s. 28.3%, p < 0.001) and stent vessel occlusion (5.3 vs. 3.4%, p = 0.037) w as significantly higher in diabetic patients. Diabetes was identified as an independent risk factor for adverse clinical events and restenosis in mult ivariate analyses. Conclusions. Patients with diabetes mellitus have a less favorable clinical outcome at one year after successful stent placement as compared to the no ndiabetic patients. The clinical follow-up was characterized by a higher in cidence of death, myocardial infarction and reinterventions. Diabetic patie nts also demonstrated an increased risk for restenosis. (J Am Coll Cardiol 1998;32:1866-73) (C) 1998 by the American College of Cardiology.