Author + information
- Received September 7, 2007
- Revision received February 12, 2008
- Accepted February 15, 2008
- Published online April 1, 2008.
- 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⁎ and
- Kevin E. Kip, PhD¶
- ↵⁎Reprint requests and correspondence:
Dr. Suresh R. Mulukutla, Cardiovascular Institute, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213.
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.
The Dynamic Registry is supported by grants HL-33292-14 through HL-33292-22 from the National Heart, Lung, and Blood Institute of the National Institutes of Health.
- Received September 7, 2007.
- Revision received February 12, 2008.
- Accepted February 15, 2008.
- American College of Cardiology Foundation