The influence of diabetes mellitus on acute and late clinical outcomes following coronary stent implantation

Abizaid, Alexandre; Kornowski, Ran; Mintz, Gary S.; Hong, Mun K.; Abizaid, Andréa S.; Mehran, Roxana; Pichard, Augusto D.; Kent, Kenneth M.; Satler, Lowell F.; Wu, Hongsheng; Popma, Jeffrey J.; Leon, Martin B.

doi:10.1016/s0735-1097(98)00286-1

Cited by 425 publications

(224 citation statements)

References 25 publications

Supporting

Mentioning

194

Contrasting

Unclassified

Order By: Relevance

“…Compared to PTCA, coronary stent implantation has been demonstrated to reduce restenosis and the subsequent requirement for revascularization for patients with a relatively narrow spectrum of coronary lesions (12,13). Although stents appear to achieve a reduction in restenosis compared to PTCA in diabetic patients (32), even with stents, diabetic patients appear to have increased restenosis when compared with nondiabetic patients (33,34).…”

Section: Discussionmentioning

confidence: 99%

Effect of Diabetes on Long-Term Mortality Following Contemporary Percutaneous Coronary Intervention

et al. 2004

View full text Add to dashboard Cite

OBJECTIVE -Diabetic patients are known to have reduced long-term survival following percutaneous transluminal coronary angioplasty compared with nondiabetic patients. However, it is unknown whether this survival disadvantage has persisted in the era of contemporary percutaneous coronary intervention (PCI) techniques, which include the widespread use of stents and the availability of platelet glycoprotein (GP) IIb/IIIa inhibitors. RESEARCH DESIGN AND METHODS -Three hospitals in New YorkCity contributed prospectively defined data on 4,284 patients undergoing PCI. The primary end point was all-cause mortality following hospital discharge for PCI.RESULTS -Hypertension, renal insufficiency, and renal failure requiring dialysis were all more common in diabetic patients, whereas active smoking was less frequent. Congestive heart failure on admission was more common in diabetic than nondiabetic patients (7.7 vs. 4.0%, P Ͻ 0.001). Stents were placed in 78% of nondiabetic patients and 75% of diabetic patients (P ϭ 0.045). Platelet GP IIb/IIIa antagonists were administered to 23% of nondiabetic and 24% of diabetic patients (P ϭ NS). At a mean follow-up of 3 years, mortality was 8% among nondiabetic patients and 13% for diabetic patients (P Ͻ 0.001). After adjustment for differences in baseline characteristics between nondiabetic and diabetic patients, diabetes remained a significant independent hazard for late mortality (hazard ratio 1.462, 95% CI 1.169 -1.828; P ϭ 0.001).CONCLUSIONS -Following contemporary PCI, diabetic patients continue to have worse survival than nondiabetic patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of Diabetes on Long-Term Mortality Following Contemporary Percutaneous Coronary Intervention

et al. 2004

View full text Add to dashboard Cite

show abstract

“…The results from a consecutive series of patients like ours and randomized trials confirm the superiority of stents to balloon PTCA, both in the hospital and late followup outcomes. In the presence of some high-risk subgroups of patients, such as those with diabetes [20][21] , unstable angina 7 , acute myocardial infarction [15][16][17][18][19] , vessels with reference size <3.0mm 7 , balloon PTCA failures 6 , lesions located in he proximal left anterior descending artery 7,22 , chronic occlusions [13][14] , vein grafts 11 , restenotic lesions 12 and multivessel coronary disease 23 , who undergo percutaneous coronary revascularization, stents will promote better results and should be the technique of first choice.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of coronary stent implantation. Acute and six month outcomes of 1,126 consecutive patients treated in 1996 and 1997

Mattos¹,

Pinto²,

Abizaid³

et al. 1999

Arq. Bras. Cardiol.

Self Cite

View full text Add to dashboard Cite

Original ArticlePurpose -The authors analyzed the 30-day and 6-month outcomes of 1,126 consecutive patients who underwent coronary stent implantation in 1996 and 1997. MI (1.3% vs 1.1%, 1996 vs 1997, emergency coronary bypass surgery (1% vs 0.6%, 1996(1% vs 0.6%, vs 1997 and 30-day death rates (0.2% vs 0.5%, 199630-day death rates (0.2% vs 0.5%, vs 1997 were similar. The 6-month restenosis rate was 25% in 1996 and 27% in 1997 (p= NS); the target vessel revascularization rate was 15% in 1996 and 16% in 1997 (p = NS). In the first years of its usage, randomized trials and many consecutive series of patients showed higher rates of thrombotic occlusion after coronary stent implantation (5 to 20%). This adverse event stimulated the use of one of the most severe antithrombotic drug regimens ever applied in interventional cardiology in an attempt to reduce the incidence of this major coronary complication. However, the series of procedures that followed this pharmacological approach did not demonstrate a reduction in the subacute occlusion rates, and major bleeding, a serious side effect, occurred. It is natural to conclude that this approach resulted in longer hospital stays with increasing costs, making physicians leery of recommending this new percutaneous coronary revascularization method 2-3 . Methods -The 30-day results and 6-month angiographic follow-up were analyzed in patients treated with coronary stents in 1996 and 1997. All patients underwent coronary stenting with high-pressure implantation (>12 atm) and antiplatelet drug regimen (aspirin plus ticlopidine). Results ConclusionsThe scenario changed, however, with the publication of the results of two major randomized studies in 1994, which compare balloon PTCA with stents. The comparison demonstrates that, stents can create significancy higher coronary lumen diameters, reduce the restenosis rate at the end of the first 6 months and as a consequence the need for further revascularization procedures, percutaneous or surgical, compared with the standard balloon PTCA method [4][5][6][7] . In 1995, Colombo et al 8 demonstrated that intravascular ultrasound could optimize stent delivery and implantation, applying higher balloon pressures (>12 ATM), promoting better stent symmetry, with a nearly full

show abstract

Section: Diabetes and The Problem Of Restenosismentioning

confidence: 99%

“…[42][43][44] Studies further demonstrated that stenting of the treated vessel does not offer full protection from restenosis and coronary events. 42,43 Even with the recent development of sirolimus-coated stents, it is not yet clear if diabetic subjects will fully benefit from this novel therapy. [45][46][47] To dissect the biochemical and molecular events linked to enhanced restenosis in diabetic human subjects, it was first necessary to establish animal models to readily address these concepts.…”

Section: Diabetes and The Problem Of Restenosismentioning

confidence: 99%

RAGE Axis

Naka

Bucciarelli

Wendt

et al. 2004

ATVB

128

View full text Add to dashboard Cite

Abstract-Receptor for AGE (RAGE) is a multi-ligand member of the immunoglobulin superfamily of cell surface molecules. Engagement of RAGE by its signal transduction ligands evokes inflammatory cell infiltration and activation in the vessel wall. In diabetes, when fueled by oxidant stress, hyperglycemia, and superimposed stresses such as hyperlipidemia or acute balloon/endothelial denuding arterial injury, the ligand-RAGE axis amplifies vascular stress and accelerates atherosclerosis and neointimal expansion. In this brief synopsis, we review the use of rodent models to test these concepts. Taken together, our findings support the premise that RAGE is an amplification step in vascular inflammation and acceleration of atherosclerosis. Future studies must rigorously test the potential impact of RAGE blockade in human subjects; such trials are on the horizon.

show abstract

The influence of diabetes mellitus on acute and late clinical outcomes following coronary stent implantation

Cited by 425 publications

References 25 publications

Effect of Diabetes on Long-Term Mortality Following Contemporary Percutaneous Coronary Intervention

Effect of Diabetes on Long-Term Mortality Following Contemporary Percutaneous Coronary Intervention

Safety and efficacy of coronary stent implantation. Acute and six month outcomes of 1,126 consecutive patients treated in 1996 and 1997

RAGE Axis

Contact Info

Product

Resources

About