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Impact of Drug-Eluting Stents Among Insulin-Treated Diabetic Patients

A Report From the National Heart, Lung, and Blood Institute Dynamic Registry

Suresh R. Mulukutla, MD^_*,_*, Helen A. Vlachos, MSc^_*, Oscar C. Marroquin, MD^_*, Faith Selzer, PhD^_*, Elizabeth M. Holper, MD, J. Dawn Abbott, MD, Warren K. Laskey, MD, David O. Williams, MD, Conrad Smith, MD^_*, William D. Anderson, MD^_*, Joon S. Lee, MD^_*, Vankeepuram Srinivas, MD^||, Sheryl F. Kelsey, PhD^_*, Kevin E. Kip, PhD^¶

^_* University of Pittsburgh, Pittsburgh, Pennsylvania
University of Texas-Southwestern, Dallas, Texas
Rhode Island Hospital, Providence, Rhode Island
University of New Mexico, Albuquerque, New Mexico
^|| Montefiore Medical Center, New York, New York
^¶ University of South Florida, Tampa, Florida.

^_* Reprint requests and correspondence: Dr. Suresh R. Mulukutla, Cardiovascular Institute, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213. (Email: mulukutlasr{at}upmc.edu).

Objectives: This study sought to evaluate the safety and efficacy of drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients with insulin- and noninsulin-treated diabetes.

Background: Diabetes is a powerful predictor of adverse events after percutaneous coronary interventions (PCI), and insulin-treated diabetic patients have worse outcomes. The DES are efficacious among patients with diabetes; however, their safety and efficacy, compared with BMS, among insulin-treated versus noninsulin-treated diabetic patients is not well established.

Methods: Using the National Heart, Lung, and Blood Institute Dynamic Registry, we evaluated 1-year outcomes of insulin-treated (n = 817) and noninsulin-treated (n = 1,749) patients with diabetes who underwent PCI with DES versus BMS.

Results: The use of DES, compared with BMS, was associated with a lower risk for repeat revascularization for both noninsulin-treated patients (adjusted hazard ratio [HR] = 0.59, 95% confidence interval [CI] 0.45 to 0.76) and insulin-treated subjects (adjusted HR = 0.63, 95% CI 0.44 to 0.90). With respect to safety in the overall diabetic population, DES use was associated with a reduction of death or myocardial infarction (adjusted HR = 0.75, 95% CI 0.58 to 0.96). However, this benefit was confined to the population of noninsulin-treated patients (adjusted HR = 0.57, 95% CI 0.41 to 0.81). Among insulin-treated patients, there was no difference in death or myocardial infarction risk between DES- and BMS-treated patients (adjusted HR = 0.95, 95% CI 0.65 to 1.39).

Conclusions: Drug-eluting stents are associated with lower risk for repeat revascularization compared with BMS in treating coronary artery disease among patients with either insulin- or noninsulin-treated diabetes. In addition, DES use is not associated with any significant increased safety risk compared with BMS. These findings suggest that DES should be the preferred strategy for diabetic patients.

Abbreviations and Acronyms   BMS = bare metal stent(s)   CABG = coronary artery bypass graft   CI = confidence interval   DES = drug-eluting stent(s)   HR = hazard ratio   MI = myocardial infarction   PCI = percutaneous coronary intervention

Related articles in JACC Interventions:

Diabetes and Drug-Eluting Stents: What You Get and What You Don’t

Steven P. Marso
JACC Interventions 2008 1: 148-149. [Full Text]  

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				S. P. Marso Diabetes and Drug-Eluting Stents: What You Get and What You Don't J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 148 - 149. [Full Text] [PDF]