TY - JOUR
T1 - Impact of coronary lesion complexity on drug-eluting stent outcomes in patients with and without diabetes mellitus
T2 - Analysis from 18 pooled randomized trials
AU - Kedhi, Elvin
AU - Généreux, Philippe
AU - Palmerini, Tullio
AU - McAndrew, Thomas C.
AU - Parise, Helen
AU - Mehran, Roxana
AU - Dangas, George D.
AU - Stone, Gregg W.
N1 - Funding Information:
Dr. Kedhi has received lecture fees from Abbott Vascular. Drs. Généreux and Palmerini have received lecture fees from Abbott Vascular. Dr. Mehran is a consultant and advisor to AstraZeneca, Janssen (Johnson & Johnson), Regado Biosciences, Abbott, Merck Sharp & Dohme, Maya Medical, Covidien, and Boston Scientific; and has received research grant support (institutional) from Bristol-Myers Squibb/Sanofi, The Medicines Company, Eli Lilly/Daiichi Sankyo, and St. Jude Medical . Dr. Dangas is a consultant to Abbott Vascular, AstraZeneca, Boston Scientific, Covidien, and Janssen; and has received institutional research grant support from Bristol-Myers Squibb/Sanofi, Eli Lilly/Daiichi Sankyo, Regado Biosciences, Maya Medical, Merck, and The Medicines Company . Dr. Stone has served as a consultant to Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2014/5/27
Y1 - 2014/5/27
N2 - Objectives The aim of this study was to investigate whether baseline lesion complexity affects drug-eluting stent (DES) outcomes according to diabetic status. Background Previous studies have reported conflicting results regarding DES safety and efficacy in patients with and without diabetes mellitus (DM). Methods Patient-level data from 18 prospective randomized trials were pooled. DES treatment outcomes in patients with versus without DM were analyzed in 2 propensity score-matched groups further stratified according to lesion complexity (American College of Cardiology and American Heart Association class A/B1 vs. B2/C). Remaining baseline differences were adjusted for by multivariate analysis. Results DM was present in 3,467 of 18,441 patients (18.8%). DM was a predictor of 1-year repeat revascularization (target lesion revascularization: hazard ratio: 1.34; 95% confidence interval: 1.05 to 1.70; target vessel revascularization: hazard ratio: 1.40; 95% confidence interval: 1.15 to 1.72) and cardiac death or myocardial infarction (hazard ratio: 1.40; 95% confidence interval: 1.09 to 1.81). Rates of target lesion and target vessel revascularization were significantly higher in patients with versus those without DM with type B2/C lesions (8.0% vs. 4.5% and 10.6% vs. 5.9%, respectively, p < 0.0001 for both), but not in patients with only type A/B1 lesions (4.6% vs. 4.8%, p = 0.87, and 7.4% vs. 6.8%, p = 0.47, respectively), with a significant interaction between DM and lesion type observed for both endpoints (p = 0.01 and p = 0.02, respectively). No interaction was observed for death or myocardial infarction (p = 0.28). Conclusions In the DES era, patients with DM remain at increased risk for cardiac death or myocardial infarction. However, DM is a risk factor for repeat revascularization only in those patients with complex lesions; patients with DM and noncomplex lesions have similar rates of 1-year freedom from repeat revascularization as do patients without DM.
AB - Objectives The aim of this study was to investigate whether baseline lesion complexity affects drug-eluting stent (DES) outcomes according to diabetic status. Background Previous studies have reported conflicting results regarding DES safety and efficacy in patients with and without diabetes mellitus (DM). Methods Patient-level data from 18 prospective randomized trials were pooled. DES treatment outcomes in patients with versus without DM were analyzed in 2 propensity score-matched groups further stratified according to lesion complexity (American College of Cardiology and American Heart Association class A/B1 vs. B2/C). Remaining baseline differences were adjusted for by multivariate analysis. Results DM was present in 3,467 of 18,441 patients (18.8%). DM was a predictor of 1-year repeat revascularization (target lesion revascularization: hazard ratio: 1.34; 95% confidence interval: 1.05 to 1.70; target vessel revascularization: hazard ratio: 1.40; 95% confidence interval: 1.15 to 1.72) and cardiac death or myocardial infarction (hazard ratio: 1.40; 95% confidence interval: 1.09 to 1.81). Rates of target lesion and target vessel revascularization were significantly higher in patients with versus those without DM with type B2/C lesions (8.0% vs. 4.5% and 10.6% vs. 5.9%, respectively, p < 0.0001 for both), but not in patients with only type A/B1 lesions (4.6% vs. 4.8%, p = 0.87, and 7.4% vs. 6.8%, p = 0.47, respectively), with a significant interaction between DM and lesion type observed for both endpoints (p = 0.01 and p = 0.02, respectively). No interaction was observed for death or myocardial infarction (p = 0.28). Conclusions In the DES era, patients with DM remain at increased risk for cardiac death or myocardial infarction. However, DM is a risk factor for repeat revascularization only in those patients with complex lesions; patients with DM and noncomplex lesions have similar rates of 1-year freedom from repeat revascularization as do patients without DM.
KW - diabetes mellitus
KW - drug-eluting stent(s)
KW - prognosis
UR - http://www.scopus.com/inward/record.url?scp=84901020817&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2014.01.064
DO - 10.1016/j.jacc.2014.01.064
M3 - Article
C2 - 24632279
AN - SCOPUS:84901020817
SN - 0735-1097
VL - 63
SP - 2111
EP - 2118
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 20
ER -