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Intrahospital and long term outcomes of coronary angioplasty with drug eluting stent, in diabetic patients compared with no diabetic

Introduction

Although randomized trials have suggested the value of drug eluting stents in a selected group of diabetic patients with "On Label" indications, very little is known about its true role in "Off Label" indications.

Objetive

Compare Intrahospital and long term outcomes of coronary angioplasty with drug eluting stent in “Off Label” indications, in diabetic patients compared with no diabetic.

Materials and methods

255 patients were treated with coronary angioplasty (CA) with drug eluting stent between 31-5 -03 and 28-2-07. 57 patients were diabetic and 159 were no diabetic, both groups were compared. The average follow-up was 22 months (6-45). Both groups were similar, with the exception of the female sex (44% in diabetic and 19.4% in no diabetic P<0.001) and in indications of coronary angioplasty because of drug elutin stent restenosis in diabetic patients: 22% vs. 7.1% in no diabetic patients P< 0.003. The CA was indicated: In diabetic patients vs. no diabetic: ostial lesions: 5% vs. 8.2%, total obstruction: 10.2% vs. 9.7%, bifurcation: 3.3% vs. 4.6%, bare stent restenosis: 13,5% vs 17,3%, drug elutin stent restenosis: 22% vs. 7,1%, average of small vessels: 2,9mm (25-40mm), average of lesion length: 10-50mm (23mm)

Demographics

  DIABETICOS
57 ptes
NO DIABETICOS
159 ptes
Male 33 (55.9%) 158 (80.6%)
Female * 26 (44.1%) 38 (19.4%)
Hipertension 35 (59.3%) 104 (53%)
Dyslipidemia 21(35%) 72 (36.7%)
Smokers 20 (33%) 70 (35.7%)
Diabetics 57 (100%) 0
Previous Myocardial infarction 18 (30.5%) 56 (28.6%)
Previous ACTP 14 (23.7%) 34 (17.3%)
Previous cardiac surgery: 4 (6.8%) 11 (5.6%)
* P>0.001

Vessel treated

  DIABETICOS NO DIABETICOS
Left main 3 (5.1%) 8 (4.1%)
LAD 37 (62,7%) 114 (58.2%)
Circunflex 9 (15.3.8%) 44 (22.4%)
Rigth Coronary 1 (1.7%) 45 (23%)
Diagonal 15 (4,5%) 9 (4,6%)
Marginal 0 3 (1,5%)

Clinical indication

  DIABETICOS NO DIABETICOS
Unastable angina 54 (91.5%) 185 (94.4%)
Stable angina 5 (8.5%) 10 (5.1%)

Lesion type

  DIABETICOS
70 lesions
NO DIABETICOS
225 lesions
TIPO A 1 (1.4%) 0
TIPO B1 2 (2,8%) 7 (3,I%)
TIPO B2 9 (12.8%) 37 (16.4%)
TIPO C 58 (82.8%) 181 (80.4%)

 

  DIABETICOS NO DIABETICOS
Diameter vessels 2,5-4.0 (mean 2,9 mm) 2,5-4.0 (mean 2,9 mm)
Lesion length 10 A 50 (mean 23 mm). 10 A 49 (mean 22 mm)

 

STENTS DIABETICOS
70 stents
NO DIABETICOS
264 stents
APOLLO 1 5 (1.8%)
COSTAR 3 22 (8.3%)
ENDEAVOR 25 80 (30.3%)
FIREBIRD 4 25 (9.4%)
CYPHER 10 42 (15.9%)
TAXUS 29 90 (34%)

Tecnic implantation

  DIABETIC NO DIABETIC
Baloon predilatation 58 ptes (98.3%) 192 ptes (98.%)
Direct stent 1 pte (1.7%) 4 ptes (2%)
posdilatation 0 2 ptes(1%)

Results

Results There were no significant differences in the success of the procedure (100% diabetic patients vs. 99.5% no diabetic ones), the survival free of cardiac death and myocardial infarction (100% diabetic patients vs. 98.8% in no diabetic ones), late thrombosis (0% in diabetic vs. 1.2 in no diabetic), cardiac mortality (0% diabetic patients vs. 0.5% in no diabetic), general mortality (1.2% in diabetic ones vs. 2.0% in no diabetic patients).
Survival free of major events was greater in no diabetic patients (89.6% vs. 79.7% in diabetic patients) at the expense of greater revascularization of the target lesion in diabetic patients (20.3% vs. 9.2 % in no diabetic) P> de 0,02.
There were 84.9% asymptomatic patients among the no diabetes vs. 72.9% of diabetic, P>0.03.
The statistic method used was chi 2, with SPSS 12.0 software, taking P as statiscally significant (P=0.05)

  Intrahospital Follow up (22 month)
  Diabetic no diabetic Diabetic no diabetic
Total death 0 0 2 3
Cardiac death 0 0 0 1 (0,5%)
AMI 0 1 (0,5%) 0 1 (0,4%)
TLR 0 0 12 ptes (20.3%) 18 ptes (9.2%)
Revasc ACTP 0 0 11 ptes (18.6%) 13 ptes (6.6%)
Revasc surgery 0 0 1 pte (1.7%) 5 ptes (2.6%)
Acute trombosis 0 1 (0,5%)    
Late trombosis 0 0 0 2 (1%)

Conclusions

Despite the use of drug eluting stents, angioplasty in "Off Label" coronary lesionsin diabetic patients had a worse evolution prospect than in the no diabetic at the expense of a higher rate of revascularization of the target lesion, without statistically significant differences in mortality and myocardial infarction, similar to the published results in literature Trials and Records.

 

Autor: Dr. Carlos Alejandro Alvarez, Dr. Fernando Ordoñez, Dr. Alberto Cristino, Dr. Carlos J. Alvarez Iorio

Ultima actualizacion: 23 DE JUNIO DE 2008

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