Type of Drug-Eluting Stents as a Strong Predictor of Major Adverse Cardiac Events in Patients with Diabetes Mellitus |
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국립의료원 내과 |
Type of Drug-Eluting Stents as a Strong Predictor of Major Adverse Cardiac Events in Patients with Diabetes Mellitus |
.Jae-Sik Jang, Myeong-Ki Hong, Duk-Woo Park, Young-Hak Kim, Cheol Whan Lee, Jae-Joong Kim, Seong Wook Park, Seung-Jung Park |
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Abstract |
Background : Despite introduction of drug-eluting stents (DESs), restenosis and subsequent adverse cardiac events are not decreased prominently
in diabetic patients. There are limited data regarding the predictors of major adverse cardiac events (MACE) in this high risk patient subgroup.
Methods : A total of 663 consecutive diabetic patients (955 lesions) who underwent successful implantation of DESs were retrospectively analyzed.
Follow-up angiography at 6 months was performed in 621 patients (94 %). All data were analyzed to identify the predictors MACE defined as
death, myocardial infarction and target lesion revascularization (TLR). Results : MACE were documented in 38 patients (5.7 %). Procedural
characteristics are shown in Table. By univariate analysis, predictors of increased MACE in diabetic patients were left main coronary involvement
(p=0.018), greater lesion length (p<0.001) and greater stented length of vessel (p=0.010), larger number of stents used (p=0.001), overlapping of
stents (p=0.003), and use of a paclitaxel-eluting stent (p=0.022). Predictor of decreased MACE was use of a sirolimus-eluting stent (p=0.014).
Multivariate analysis showed that greater lesion length (OR 1.04, 95 % CI 1.02 to 1.06, p<0.001) and use of a sirolimus-eluting stent (OR 0.32, 95
% CI 0.14 to 0.70, p=0.005) were independent predictors of MACE in diabetic patients. Conclusions : The type of DESs deployed is a significant
predictor of MACE in addition to angiographic and procedural characteristics, such as reference vessel size and lesion length in patients with
diabetes mellitus. |
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