The Association of Diabetes Mellitus with Clinical Outcomes after Coronary Stenting: A Meta-Analysis

Abstract

BackgroundPrevious studies have shown inconsistent results on the association between diabetes mellitus (DM) and some clinical outcomes. We conducted a meta-analysis of observational studies to assess effect of DM on clinical outcomes after coronary stenting.MethodsWe searched for studies without language restriction in PubMed, Embase and Cochrane library prior to 2012. The clinical outcomes including in-stent restenosis (ISR), major adverse cardiac events (MACE), stent thrombosis (ST), target lesion revascularization (TLR) and target vessel revascularization (TVR). Adjusted odds ratio (OR), and the corresponding 95% confidence interval (95% CI) was summarized.Results55 studies involving 128,084 total patients (38,416 DM patients and 89,668 controls) were eligible for our analysis. Overall, there were significant associations between DM and ISR (OR = 1.70, 95% CI: 1.53–1.89, I2 = 0.0%), MACE (OR = 1.54, 95% CI: 1.36–1.73, I2 = 29.0%), ST (OR = 2.01, 95% CI: 1.36–2.97, I2 = 47.7%), TLR (OR = 1.46, 95% CI: 1.26–1.68, I2 = 43.3%) as well as TVR (OR = 1.33, 95% CI: 1.17–1.51, I2 = 48.3). Subgroup analysis showed that the associations were similar between BMS and DES implantation. Moreover, there was no significant association in the ST subgroup after 1–3 years follow-up.ConclusionsOur meta-analysis suggests that after coronary stent implantation, DM is associated with ISR, MACE, ST, TLR and TVR. DM appears to be a vital risk factor of these clinical outcomes.

Occurrence and predictive risk factors associated with in-stent restenosis after drug-eluting stent implantation in diabetic patients: a prospective, clinical cohort study

“…Notably, DM itself can lead to a greater inflammatory response, and a more diffuse and rapid progression of atherosclerosis [7]. The ISR occurrence rate in patients with DM is 10% higher than that in patients without DM [14][15][16]. Our study found that ISR accounted for 20/98 vs 27/262 in DM and non-DM populations respectively (P < 0.05), which was consistent with previous studies.…”

Impact of diabetes on neutrophil-to-lymphocyte ratio and its relationship to coronary artery disease

“…However, despite the introduction of more potent antiplatelet agents and new techniques for percutaneous revascularization, the results have, so far, proven unsatisfactory, with diabetic patients still experiencing a higher rate of cardiovascular events and poorer outcomes, especially in the setting of acute coronary syndromes [3][4][5]. For this reason, considerable attention has been directed towards the identification of new markers of cardiovascular risk in such patients [6,7].…”

Evolution of coronary stents in patients with diabetes: are clinical outcomes still improving?

“…This was confirmed by a meta-analysis revealing an odds ratio (OR) of 1.76 and a 95% CI of 1.54-2 between the association of diabetic patients and BMS angiographic in-stent restenosis (ISR) and an OR of 1.68 and a 95% CI of 1.25-2.26 for major adverse cardiac events (MACE) defined as a composite of cardiac death, myocardial infarction (MI) and repeat PCI performed to revascularize the index lesion [6]. In another compilation of 16 PCI studies with 6-month angiographic follow-up, 31.1% of diabetic patients had angiographic restenosis and this appeared to be related to a smaller reference vessel diameter and longer stents required to complete treatment [7].…”