Influence of diabetes mellitus on early and late clinical outcomes in saphenous vein craft stenting

OBJECTIVES The purpose of this study was to compare early and late clinical outcomes in diabetic and nondiabetic patients after stent implantation in saphenous vein grafts (SVG). BACKGROUND Patients with diabetes mellitus have less favorable acute and lo ng-term outcomes after stent implantation in native coronary arteries. The impact of diabetes on SVG stenting, however, is not known. METHODS We studied 908 consecutive patients (1,366 SVG lesions) treated wit h Palmaz-Schatz stents. In-hospital and late clinical outcomes (death, Q-wa ve myocardial infarction and repeat revascularization rates at one year) we re compared between diabetic (n = 290) and nondiabetic (n = 618) patients. RESULTS In-hospital mortality was significantly higher in diabetic as compa red With nondiabetic patients (2.2% vs. 0.3%, p = 0.003). At one-year follo w-up, target lesion revascularization (TLR) was 16.6% in diabetic and 12.3% in nondiabetic patients (p = 0.03). Overall cardiac event-free survival (f reedom from death, Q-wave myocardial infarction and any coronary revascular ization procedure) at one year was significantly lower in the diabetic (68% ) compared with the nondiabetic patients (79%, p = 0.0003). By Cox regressi on analysis, diabetes mellitus was an independent predictor of both TLR (re lative risk: 1.23; confidence interval: 0.96 to 1.58; p = 0.004) and late c ardiac events (relative risk: 1.40; confidence interval: 1.05 to 1.86; p = 0.02). CONCLUSIONS Patients with diabetes undergoing stent implantation in SVG hav e: 1) higher in-hospital and late mortality, 2) higher one-year TLR rates, and 3) significantly lower one-year cardiac event-free survival. Thus, diab etic patients have less favorable acute and late clinical outcomes after st ent implantation in SVG lesions. CT Am Coil Cardiol 2000;36:1186-93) (C) 20 00 by the American College of Cardiology.