Coronary stent implantation in diabetic versus nondiabetic patients. Early and late outcomes

Dm, Bayerl; Siqueira, E J; Moscoso, Isaac; Santos, Elizabete Silva dos; Maeda, Atsuo; Bittencourt, Otavio Neves da Silva; Mf, Mauro; Cristóvão, Salvador André Bavaresco; Salman, Adnan Ali; Sanches, Guilherme Trafani; Ja, Mangione

doi:10.1590/s0066-782x2000001100001

Cited by 7 publications

(8 citation statements)

References 19 publications

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“…According to the clinical characteristics of patients, most cardiovascular risk factors and comorbidities were more common in diabetics, which would indicate a poor clinical outcome in this group. [8][9][10][11][12] However, the present findings demonstrated no influence of diabetes on clinically adverse events at the hospitalisation phase, despite the greater clinical complexity of patients. The angiographic profile of diabetic patients, however, showed no diffe rence for most analysed variables compared with non-diabetics, which suggests that the appropriate choice of cases attenuated the higher number of in-hospital events expected for that group.…”

Section: Discussioncontrasting

confidence: 50%

“…The presence of diabetes mellitus in patients with atherosclerotic disease is a marker of poor prognosis when they are submitted to PCI, with a higher incidence of complications and restenosis. [8][9][10] It is believed that this is due to endothelial and metabolic alterations, which lead to a greater chance of atherosclerotic plaque rupture and thrombus formation and increased exacerbation of intimal hyperplasia. [10][11][12] In the present study, the impact of diabetes mellitus on in-hospital outcomes was evaluated in a large cohort of patients currently undergoing PCI.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17] The observation of a poorer prognosis in diabetic patients is more consistent in the late outcome after PCI, which may be explained by higher rates of restenosis and disease progression in this group of patients. 1,[8][9][10] In Brazil, the Drug-Eluting Stent in the Real World (DESIRE registry), 18 which assessed the predictors of target lesion revascularisation in a long-term clinical follow-up, demonstrated that diabetes mellitus predisposes individuals to a greater need for new procedures. A subanalysis of the same registry, which evaluated the late outcome after PCI with drug-eluting stents in diabetic patients, showed that, when analysed in combination, major cardiac events occurred more frequently in the diabetic group, although still at very low rates.…”

Section: Discussionmentioning

confidence: 99%

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Resultados hospitalares da intervenção coronária percutânea em diabéticos

Coelho¹,

Cantarelli²,

Castello³

et al. 2012

Rev. Bras. Cardiol. Invasiva

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Background: There are few available reports in the literature assessing in-hospital outcomes of diabetic patients currently undergoing percutaneous coronary intervention (PCI). This article aimed to assess the acute post-PCI outcomes of a large series of diabetic and non-diabetic patients treated consecutively. Methods: From August 2006 to February 2012, 6,011 patients were submitted to PCI and included in the registry of the Hospital Bandeirantes. The techniques and devices for the procedure were chosen by the surgeons. Clinical outcomes were registered at the time of hospital discharge. Results: Diabetic patients were older and more frequently females, with a higher prevalence of comorbidities and risk factors for coronary artery disease, except for smoking. However, most of the characteristics related to lesion complexity did not differ between groups. In diabetics, the number of treated vessels (1.6 ± 0.8 vs. 1.4 ± 0.7; P < 0.01) was higher, and the use of smaller stents (2.9 ± 0.5 mm vs. 3 ± 0.5 mm; P < 0.01) was more frequent. A procedural success rate of 95.5% was achieved in both groups. In-hospital outcomes did not differ in the incidence of major adverse cardiac and cerebrovascular events (3.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Resultados hospitalares da intervenção coronária percutânea em diabéticos

Coelho¹,

Cantarelli²,

Castello³

et al. 2012

Rev. Bras. Cardiol. Invasiva

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“…Em nosso meio, poucos estudos analisaram a evolução clínica de pacientes com DM tratados com implantes de stents coronarianos (15,16). Recentemente, descrevemos a experiência do Instituto de Cardiologia de Porto Alegre com o implante de stents convencionais em 208 pacientes com DM que foram comparados com um grupo controle sem DM (n= 685), sendo avaliados os resultados hospitalares e o seguimento clínico em um ano (12).…”

Section: Intervenção Coronariana Percutânea (Icp)unclassified

Intervenção coronária percutânea no diabetes mellitus: análise da prática médica atual

Quadros

Diemer

Lima

et al. 2007

Arq Bras Endocrinol Metab

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RESUMOOs pacientes com diabetes e cardiopatia isquêmica são freqüentemente considerados para a realização de revascularização miocárdica com o objetivo de diminuição do risco de eventos cardiovasculares ou melhora da qualidade de vida. Na prática clínica, as decisões quanto à realização de cirurgia ou intervenção coronariana percutânea são freqüentemente difíceis, devido à gravidade dos casos, extensão da doença e presença de co-morbidades. Além disso, a maioria dos dados disponíveis na literatura origina-se da análise de subgrupos de ensaios clínicos delineados para estudos da população em geral, não para diabéticos. O objetivo deste estudo foi revisar a literatura quanto à intervenção coronária percutânea em pacientes com diabetes, além de mostrar dados mais recentes dos resultados deste procedimento no Serviço de Hemodinâmica do Instituto de Cardiologia do RS. Patients with diabetes and coronary artery disease are frequently considered for myocardial revascularization procedures, aiming at cardiovascular events risk reduction and a better quality of life. In clinical practice, decisions concerning surgery or percutaneous coronary intervention are frequently difficult, because of cases' severity, disease extension and co-morbidities association. Beyond that, the bulk of literature information was generated by subgroup analysis of randomized clinical trials, which were designed for the general population, not for diabetics. The aim of this study was to review literature on coronary percutaneous intervention in diabetic patients, and also to show recent data from the experience in this procedure at the Catheterization Laboratory of the Cardiology Institute of RS. O AUMENTO DO RISCO CARDIOVASCULAR associado ao diabetes mellitus (DM) está relacionado à própria doença (1,2) e à presença de outros fatores de risco para doenças cardiovasculares (1,3). Após o diagnóstico de doença cardiovascular, o paciente com diabetes também apresenta mais complicações e maior mortalidade do que aqueles indivíduos sem diabetes (4). O aumento da incidência de DM observado nos últimos anos (5) indica a necessidade de medidas preventivas e tratamento diferenciado para esses pacientes.

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“…(11) foram os primeiros autores a descreverem uma maior freqüência de re-estenose em indivíduos com DM comparados a indivíduos sem DM que usaram stents, achado que foi confirmado por diversos outros estudos (12)(13)(14)(15). Em nosso meio, apenas dois estudos analisaram a evolução clínica de pacientes com DM tratados com implantes de stents coronarianos, ambos com número reduzido de pacientes, e um deles abordando especificamente a fase aguda do infarto do miocárdio (16,17).…”

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Diabetes e implante de stents coronarianos: experiência de um centro de referência em cardiologia intervencionista

Schaan

Quadros

Sarmento‐Leite

et al. 2006

Arq Bras Endocrinol Metab

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We evaluated the influence of diabetes mellitus (DM) on clinical outcomes in patients with coronary artery disease treated with stent implantation. Between 1996 and 2000, 934 stents were implanted in 893 patients in our institution; 23% of them had DM. Clinical and angiographic characteristics and clinical outcomes of the patients with and without DM were prospectively included in a computerized database. Diabetics were older (61.5 +/- 10 vs. 59.8 +/- 11 years; p = 0.04) and had a higher prevalence of hypertension (69% vs. 62%; p = 0.09). The procedural clinical success rate (successful coronary stenting with residual stenosis < 30%, TIMI 3 flow and no in-hospital adverse clinical event) was lower in the diabetic group (88% vs. 92%; p = 0.05). In the 1-year follow up, diabetic patients showed higher rates of new target vessel revascularization (12.3% vs. 8%; p = 0.06), death (5.4% vs. 2.5%; p = 0.03) and major adverse cardiovascular events (MACE, new angioplasty, surgery, acute myocardial infarction or death: 16.3% vs. 9.3%; p = 0.003). Diabetes was independently associated to 1-year MACE on multivariate analysis (OR: 2.00; IC: 1.25-3.24; = 0.004). We concluded that DM is associated with higher complication and restenosis rates and a higher risk of long-term major cardiovascular events in patients treated with coronary stent implantation.

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Coronary stent implantation in diabetic versus nondiabetic patients. Early and late outcomes

Cited by 7 publications

References 19 publications

Resultados hospitalares da intervenção coronária percutânea em diabéticos

Resultados hospitalares da intervenção coronária percutânea em diabéticos

Intervenção coronária percutânea no diabetes mellitus: análise da prática médica atual

Diabetes e implante de stents coronarianos: experiência de um centro de referência em cardiologia intervencionista

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