High Event Rate After a First Percutaneous Coronary Intervention in Patients With Diabetes Mellitus

Ritsinger, Viveca; Saleh, Nawsad; Lagerqvist, Bo; Norhammar, Anna

doi:10.1161/circinterventions.114.002328

Cited by 61 publications

(38 citation statements)

References 26 publications

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“…3,4 Among patients undergoing coronary stenting, patients with DM also have a higher risk for stent thrombosis. 5 Part of the effect of DM may be explained by the contribution of insulin resistance and hyperglycemia to a prothrombotic state including direct effects on platelet function, both adhesion and aggregation, resulting in hyperreactivity. [6][7][8] This is particularly important after coronary stenting where platelet reactivity is a major risk factor for thrombotic complications.…”

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confidence: 99%

Diabetes Mellitus and Prevention of Late Myocardial Infarction After Coronary Stenting in the Randomized Dual Antiplatelet Therapy Study

et al. 2016

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Background— Patients with diabetes mellitus (DM) are at high risk for recurrent ischemic events after coronary stenting. We assessed the effects of continued thienopyridine among patients with DM participating in the Dual Antiplatelet Therapy (DAPT) Study as a prespecified analysis. Methods and Results— After coronary stent placement and 12 months treatment with open-label thienopyridine plus aspirin, 11 648 patients free of ischemic or bleeding events and who were medication compliant were randomly assigned to continued thienopyridine or placebo, in addition to aspirin, for 18 more months. After randomization, patients with DM (n=3391), in comparison with patients without DM (n=8257), had increased composite outcome of death, myocardial infarction (MI), or stroke (6.8% versus 4.3%, P <0.001), increased death (2.5% versus 1.4%, P <0.001), and MI (4.2% versus 2.6%, P <0.001). Among patients with DM, in a comparison of continued thienopyridine versus placebo, rates of stent thrombosis were 0.5% versus 1.1%, P =0.06, and rates of MI were 3.5% versus 4.8%, P =0.058; and among patients without DM the rates were 0.4% versus 1.4%, P <0.001 (stent thrombosis, P interaction=0.21) and 1.6% versus 3.6%, P <0.001 (MI, P interaction=0.02). Bleeding risk with continued thienopyridine was similar among patients with or without DM (interaction P =0.61). Conclusions— In patients with DM, continued thienopyridine beyond 1 year after coronary stenting is associated with reduced risk of MI, although this benefit is attenuated in comparison with patients without DM. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00977938.

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confidence: 99%

Diabetes Mellitus and Prevention of Late Myocardial Infarction After Coronary Stenting in the Randomized Dual Antiplatelet Therapy Study

et al. 2016

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“…Diabetic patients are at increased risk of adverse clinical outcomes after PCI . Not only are patients with diabetes more likely to have multiple comorbidities increasing the risk of cardiac death, but increased rates of TLR are observed in these patients . New treatment strategies specifically aimed at diabetic patients are needed to improve long‐term clinical outcomes after stenting.…”

Section: Discussion and Limitationsmentioning

confidence: 99%

Three‐year clinical outcomes after dual‐therapy COMBO stent placement: Insights from the REMEDEE registry

Kalkman

Kerkmeijer

Menown

et al. 2018

Cathet Cardio Intervent

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Background The bio‐engineered COMBO stent (OrbusNeich Medical BV, The Netherlands) is a dual‐therapy pro‐healing stent. This novel technology may allow a shorter duration of dual antiplatelet therapy (DAPT) after stenting. We present the first 3 year clinical outcomes of patients treated with COMBO stent. Methods and results The prospective, multicenter, investigator‐initiated, all‐comers REMEDEE Registry evaluates clinical outcomes after COMBO stent treatment. A 1,000 patients were enrolled between June 2013 and March 2014. Patients had a mean of 65 years ±11, 26% of the patients were females and 18% diabetics. More than 50% of patients presented with acute coronary syndrome, 60% of treated lesions were AHA/ACC lesion type B2 or C. Target lesion failure (TLF) at 3 year follow‐up occurred in 10.7% of patients (N = 105). The separate components cardiac death, target vessel myocardial infarction and target lesion revascularization occurred in 4.1%, 2.0%, and 7.1%, respectively of patients. Definite stent thrombosis (ST) was observed in 0.7% of all patients. At 3‐year follow‐up there were only 73 patients taking DAPT. Conclusions At 3‐year follow‐up, patients treated with COMBO stent in the present large prospective all‐comers cohort, continue to show good clinical outcomes. http://Clinicaltrials.gov identifier: NCT01874002. Condensed abstract The COMBO stent is a sirolimus‐eluting stent with a luminal anti‐CD34‐antibody layer, that binds endothelial progenitor cells. These cells can differentiate to endothelial cells and stimulate early endothelialization of the stent. The REMEDEE Registry is the first large, multicenter, prospective, cohort study evaluating the clinical outcomes of 1,000 all‐comers patients treated with COMBO stent. Target lesion failure at 3 year follow‐up was 10.7% and the rate of definite ST was 0.7%.

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“…В то же время данные Swedish Coronary Angiography and Angioplasty Registry (SCAAR, 2015) подвергают серьез-ным сомнениям кардиопротекцию инсулина в реальной клинической практике [28]. Результаты Интересны результаты ORIGIN, включавшего лиц с ССС в анамнезе или их факторами риска на фоне СД2/ НТГ (впервые диагностированных или с небольшим ста-жем), получавших гларгин (n = 12 557).…”

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Problems of hypoglycemic therapy in diabetic patients with acute coronary syndrome

Руяткина¹,

Руяткин²,

Ovsyannikova³

2016

Med. sov.

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High Event Rate After a First Percutaneous Coronary Intervention in Patients With Diabetes Mellitus

Cited by 61 publications

References 26 publications

Diabetes Mellitus and Prevention of Late Myocardial Infarction After Coronary Stenting in the Randomized Dual Antiplatelet Therapy Study

Diabetes Mellitus and Prevention of Late Myocardial Infarction After Coronary Stenting in the Randomized Dual Antiplatelet Therapy Study

Three‐year clinical outcomes after dual‐therapy COMBO stent placement: Insights from the REMEDEE registry

Problems of hypoglycemic therapy in diabetic patients with acute coronary syndrome

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