Long-term clinical results of coronary angioplasty with sirolimus-eluting stents in patients with Type 2 diabetes mellitus
Abstract
Aim. To assess the long-term results of coronary artery stenting (CAS) with drug-eluting stents (DES) in patients with coronary heart disease (CHD) and Type 2 diabetes mellitus (DM-2).
Material and methods. CAS results were analyzed for 99 male and female CHD patients with angina and DM-2. In total, 78 sirolimus-eluting stents were implanted in 53 patients, and 57 non-DES were implanted in 46 individuals. In both groups, lethality and complication incidence were assessed, including the rates of recurrent angina, myocardial infarction, coronary artery bypass graft surgery, repeated endovascular intervention (EI) in the first 12 months after coronary angioplasty and in 2,5 years after EI.
Results. DES usage reduced 12-month incidence of severe cardiovascular events (CVE) from 28,9% to 9,4%, and recurrent angina incidence – from 37,8% to 17%. Decrease in severe CVE rates was explained by reduction in repeated CA angioplasty – from 22% to 5,7%. In DES group, reduced long-term incidence was observed for severe CVE – from 40% to 18,9% and recurrent angina – from 44,4% to 22,6%.
Conclusion. Endovascular myocardial revascularization with DES reduced 12-month risk of severe CVE and recurrent angina in patients with CHD and DM-2. This positive tendency remained for at least 2,5 years after coronary angioplasty.About the Authors
K. N. PetrovaRussian Federation
S. G. Kozlov
Russian Federation
A. A. Lyakishev
Russian Federation
A. P. Savchenko
Russian Federation
References
1. Morgan KP, Kapur A, Beatt KJ. Anatomy of coronary disease in diabetic patients: an explanation for poorer outcomes after percutaneous coronary intervention and potential target for intervention. Heart 2004; 90: 732–8.
2. Mathew V, Gersh BJ, Williams BA, et al. Outcomes in patients with diabetes mellitus undergoing percutaneous coronary intervention in the current era: a report from the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial. Circulation 2004; 109: 476–80.
3. Abizaid A, Costa MA, Blanchard D, et al. Sirolimus-Eluting Stents Inhibit Neointimal Hyperplasia in Diabetic Patients. Insights from the RAVEL Trial. Eur Heart J 2004; 25: 107–12.
4. Moussa I, Leon MB, Baim DS, et al. Impact of SirolimusEluting Stents on Outcome in Diabetic Patients. Circulation 2004; 109: 2273–8.
5. Hermiller JB, Raizner A, Cannon L, et al.; TAXUS-IV Investigators. Outcomes With the Polymer-Based Paclitaxel-Eluting TAXUS Stent in Patients With Diabetes Mellitus: the TAXUS-IV trial. JACC 2005; 45: 1172–9.
6. Sabatй M, Jimйnez-Quevedo P, Angiolillo DJ, et al. Randomized Comparison of Sirolimus-Eluting Stent Versus Standard Stent for Percutaneous Coronary Revascularization in Diabetic Patients. The Diabetes and Sirolimus-Eluting Stent (DIABETES) Trial. Circulation 2005; 112: 2175–83.
7. World Health Organization: Report of a WHO Consultation: Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Geneva, World Health Organization, 1999.
8. Smith SC, Feldman TE, Hirshfeld JW, et al. ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). Circulation 2006; 113: e166–286.
9. Baumgart D, Klauss V, Baer F, et al. for the SCORPIUS Study Investigators. One-Year Results of the SCORPIUS Study: A German Multicenter Investigation on the Effectiveness of Sirolimus-Eluting Stents in Diabetic Patients. JACC 2007; 50: 1627–34.
10. Mulukutla SR, Vlachos HA, Marroquin OC, et al. Impact of Drug-Eluting Stents Among Insulin-Treated Diabetic Patients: A Report From the National Heart, Lung, and Blood Institute Dynamic Registry. JACC 2008; 1: 139–47.
11. Fajadet J, Morice M-C, Bode C, et al. Maintenance of Long-Term Clinical Benefit With Sirolimus-Eluting Coronary Stents. Three-Year Results of the RAVEL Trial. Circulation 2005; 111: 1040–4.
12. Weisz G, Leon MB, Holmes DR, et al. Two-Year Clinical Outcomes After Sirolimus-Eluting Stent Implantation/ Results From the SirolImus-Eluting stent in de Novo Native Coronary Lesions (SIRIUS) Trial. JACC 2006; 47: 1350–5.
Review
For citations:
Petrova K.N., Kozlov S.G., Lyakishev A.A., Savchenko A.P. Long-term clinical results of coronary angioplasty with sirolimus-eluting stents in patients with Type 2 diabetes mellitus. Cardiovascular Therapy and Prevention. 2008;7(5):30-35. (In Russ.)