Badour Sanaa A, Dimitrova Kamellia R, Kanei Yumiko, Tranbaugh Robert F, Hajjar Mark M, Kabour Ameer, Schwann Thomas A, Alam Samir, Badr Kamal, Habib Robert H
Department of Internal Medicine, Vascular Medicine Program and Outcomes Research Unit, American University of Beirut, Lebanon.
Divisions of Cardiology, Mount Sinai Beth Israel Medical Center, New York, NY, USA.
Cardiovasc Revasc Med. 2017 Jun;18(4):265-273. doi: 10.1016/j.carrev.2017.01.012. Epub 2017 Feb 6.
BACKGROUND/PURPOSE: Diabetes portends an increased risk of adverse early and late outcomes in patients undergoing PCI. In this study, we aimed to investigate if the adverse effect of diabetes mellitus (DM) on early and late PCI outcomes is reduced with drug-eluting (DES) compared to bare-metal (BMS) stents.
METHODS/MATERIALS: We reviewed the Mount Sinai Beth Israel Hospital first PCI experience for multivessel coronary artery disease (CAD, 1998-2009). Patients were excluded if they had single-vessel CAD, emergency, no stent, prior bypass graft or myocardial infarction <24h. Diabetes-effect was derived from 9-year all-cause mortality and re-intervention risk-adjusted hazard ratios [AHR (95% confidence intervals)] for DES (N=2679; 48% three-vessel; 39% DM) and BMS (N=2651; 40% three-vessel; 33% DM) and then stratified based on stent (DES/BMS) and vessel disease (two/three).
Diabetes-effect on mortality was lower for DES (AHR=1.41 [1.14-1.74]) versus BMS (AHR=1.71 [1.50-2.01]), but this was predominantly driven by two-vessel patients. This diabetes effect was similar for first (DES1: AHR=1.43 [1.14-1.79]) and second (DES2: AHR=1.53 [0.77-3.07]) generation DES. Re-intervention comparisons were similarly increased by diabetes in all sub-cohorts.
Our analysis of a large real-world PCI series indicates that diabetes is associated with worse 9-year mortality irrespective of stent type, albeit this is mitigated to varying degrees with DES, particularly in DES2 and in case of 2-vessel disease. A complementary stent-effect analysis confirmed DES-to-BMS and DES2-to-DES1 superiority in both diabetics and non-diabetics.
背景/目的：糖尿病预示着接受经皮冠状动脉介入治疗（PCI）的患者早期和晚期出现不良结局的风险增加。在本研究中，我们旨在调查与裸金属支架（BMS）相比，药物洗脱支架（DES）是否能降低糖尿病（DM）对PCI早期和晚期结局的不良影响。
方法/材料：我们回顾了西奈山贝斯以色列医院1998 - 2009年多支冠状动脉疾病（CAD）的首次PCI经验。如果患者患有单支冠状动脉疾病、急诊情况、未植入支架、既往有搭桥手术或心肌梗死时间<24小时，则将其排除。糖尿病效应源自DES（n = 2679；48%为三支血管病变；39%为糖尿病患者）和BMS（n = 2651；40%为三支血管病变；33%为糖尿病患者）的9年全因死亡率和再干预风险调整后的风险比[AHR（95%置信区间）]，然后根据支架类型（DES/BMS）和血管病变情况（两支/三支）进行分层。
DES组（AHR = 1.41 [1.14 - 1.74]）糖尿病对死亡率的影响低于BMS组（AHR = 1.71 [1.50 - 2.01]），但这主要是由两支血管病变的患者驱动的。第一代（DES1：AHR = 1.43 [1.14 - 1.79]）和第二代（DES2：AHR = 1.53 [0.77 - 3.07]）DES的糖尿病效应相似。在所有亚组中，糖尿病同样增加了再干预的发生率。
我们对一个大型真实世界PCI系列的分析表明，无论支架类型如何，糖尿病都与9年死亡率升高相关，尽管DES在不同程度上减轻了这种情况，特别是在DES2以及两支血管病变的情况下。一项补充的支架效应分析证实了DES相对于BMS以及DES2相对于DES1在糖尿病患者和非糖尿病患者中均具有优势。
