Author + information
- S1936879815020749-5cef520ad82cd05f73cd8269748322abVivian G. Ng1,
- S1936879815020749-336259ec016c6aa06fa7c24ecd39d0d3Ashok Seth2,
- S1936879815020749-8c18d168b267125d20ea1051aaf0f762Imran Alkhalil1,
- S1936879815020749-8a8e0a1e5ecba9e9db0603d11657ebadEberhard Grube3,
- S1936879815020749-4e14a78708c584c216fdd76bfc407da2Marie-Claude Morice4,
- S1936879815020749-51b15462b533eda3445046877794812eVivian Mao5,
- S1936879815020749-ed7b87682534d6724c2547b42739540cRegina Deible5,
- S1936879815020749-eb87f0f3c492a49fac090208c91d69b9Krishnankutty Sudhir5 and
- S1936879815020749-93f58e87e69f3a8be883423e2b553ed9Alexandra J. Lansky1
Revascularization of diabetic patients is challenging owing to the high frequency of complex disease and is consistently associated with increased rates of cardiac events compared to non-diabetic patients. We evaluated the impact of diabetes on clinical outcomes among patients undergoing percutaneous coronary intervention (PCI) with the Xience V Everolimus eluting stent.
Methods and Results
We performed a patient-level pooled analysis of 4 large international post marketing surveillance registries (SPIRIT V, SPIRIT Women, XIENCE V India and the XIENCE V China Single-Arm study). Of 7592 patients, 5205 patients were non-diabetics and 2387 patients were diabetic. Diabetics were older, and had higher rates of hypertension, hyperlipidemia, and complex disease. At 2-year follow-up, diabetic patients had higher rates of all cause mortality (3.3% vs. 1.6%; p<0.0001), myocardial infarction (4.3% vs. 3.2%; p=0.02), target lesion failure (6.8% vs. 5.0%; p=0.003), and definite/probable stent thrombosis (0.8% vs. 0.4%; p=0.02) compared to non-diabetics. Among the diabetic subgroup, insulin dependent diabetics had higher events for all clinical outcome measures at 2-year follow-up compared to non-insulin dependent diabetics. Among diabetics, female gender was an independent predictor of 2-year target lesion revascularization (OR [95%CI] 2.30 [1.35, 3.93]; p=0.002), while ACC/AHA lesion class A/B1 predicted lower rates of 2-year target lesion revascularization (OR [95%CI] 0.46 [0.23, 0.92]; p=0.03). Increasing age was the only predictor of 2-year mortality in diabetic patients (OR [95%CI] 1.07 [1.04, 1.10], p<0.0001).
Although diabetic patients continue to have worse outcomes after PCI, treatment with the Xience V stent is associated with low event rates in both diabetic and non-diabetic patients. Among diabetic patients, worse outcomes following stenting with Xience V appear to be confined to those receiving insulin therapy, while non-insulin dependent diabetic patients had similar outcomes compared to non-diabetics. Gender, lesion complexity and age are significant predictors of outcomes.