Diabetes mellitus is independently associated with early stent thrombosis in patients undergoing drug eluting stent implantation: Analysis from the Victorian cardiac outcomes registry

Abstract

Background: Diabetes mellitus (DM) is a predictor of restenosis and late stent thrombosis (ST) in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting-stents (DES). Real-world data on rates of early ST is lacking. We compared clinical outcomes of patients with and without DM from the Victorian cardiac outcomes registry.Methods: Consecutive patients undergoing PCI with DES were analyzed with primary outcome being ST at 30-days. Secondary outcomes including major adverse cardiovascular events (MACE) and all-cause mortality.Results: Of 43,209 patients included, 9730 (22.5%) had DM. At 30 days, DM was independently associated with higher rates of early ST (0.7% vs. 0.5%) OR 1.41 (95% confidence interval; 1.05-1.87, p = 0.02), MACE (4.1% vs. 3.5%, p = 0.004) and mortality (1.9% vs. 1.5%, p = 0.01). Increased risk was not simply due to treatment.Patients with DM requiring insulin were equally affected in regard to MACE (4.7% vs.3.9%, p = 0.069) and mortality (1.9%, vs. 1.8%, p = 0.746). On National Death Index linkage, patients with DM had increased all-cause mortality over five-year follow-up (OR 1.69 CI 1.55-1.83, p = < 0.001). Conclusion:In this large real-world-registry, DM was an independent predictor of early ST, MACE and mortality at 30 days. These data suggest additional therapeutic strategies are required to reduce the risk of early complications in patients with DM undergoing PCI with DES.

Patient-Related Factors Predicting Stent Thrombosis in Percutaneous Coronary Interventions

“…Nevertheless, a recent analysis of the Victorian circadian cardiac outcome registry, which included 43,209 patients (out of which 22.5% had DM), appeared to show statistically significant higher rates of early ST in this population, with DM being an independent predictor of early ST [91]. It is important to note, however, that the timing of ST in the diabetic population remains controversial, with investigations into the role of EST being insufficient.…”

Drug-coated balloon-based versus drug-eluting stent-only revascularization in patients with diabetes and multivessel coronary artery disease

“…Patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI) have worse clinical outcomes, such as increased risk of in-stent restenosis (ISR), stent thrombosis, myocardial infarction, and death, compared with that of patients without DM [ 1 – 3 ]. Furthermore, patients with DM often have disease that is diffuse, long, and multivessel, and they require multivessel revascularization by either PCI or coronary artery bypass graft (CABG) [ 4 , 5 ].…”

Clinical outcomes guided by quantitative flow ratio in multivessel disease and ST-elevation myocardial infarction patients with diabetes mellitus

“…Diabetes mellitus (DM) is an independent risk factor for coronary artery disease (CAD) [1]. Patients with DM have more complex coronary anatomy (more frequently multivessel and diffuse epicardial CAD with calci cation and negative remodeling, often with microvascular disease), more high risk lipidic "vulnerable" plaques, more frequent comorbidities (including hypertension, renal dysfunction, and heart failure), and a higher risk of stent-related complications, including thrombosis and restenosis, compared with patients without diabetes [2][3][4]. Multivessel disease and ST-elevation myocardial infarction (MVD-STEMI) patients had worst prognosis in different types of CAD [5].…”