The Impact of Diabetes Mellitus on Clinical Outcomes after Percutaneous Coronary Intervention with Different Stent Sizes
-
Mohammad Javad Zibaeenezhad
,
Mehrab Sayadi
,
Seyyed Saeed Mohammadi
,
Soorena Khorshidi
,
Ehsan Hadiyan
,
Neda Rasouli
,
Ali Karimi-Akhormeh
,
Iman Razeghian-Jahromi
Abstract
Background: This study aimed to investigate the possible relationship between different stent sizes and clinical outcomes after percutaneous coronary intervention (PCI) in patients with diabetes treated with drug-eluting stents (DESs) and dual antiplatelet therapy (DAPT).
Methods: Patients with stable coronary artery disease undergoing elective PCI with the DES were entered into a retrospective cohort between 2003 and 2019. Major adverse cardiac events (MACE), defined as the combined endpoint of revascularization, myocardial infarction, and cardiovascular death, were recorded. The participants were categorized according to the stent size: 27 mm for length and 3 mm for diameter. DAPT (aspirin and clopidogrel) was used for at least 2 years for diabetics and 1 year for nondiabetics. The median duration of follow-up was 74.7 months.
Results: Out of 1630 participants, 29.0% had diabetes. The diabetics constituted 37.8% of those with MACE. The mean diameter of the stents in the diabetics and nondiabetics was 2.81±0.29 mm and 2.90±0.35 mm, respectively (P>0.05). The mean stent length was 19.48±7.58 mm and 18.92±6.64 mm in the diabetics and nondiabetics, respectively (P>0.05). After adjustments for confounding variables, MACE was not significantly different between the patients with and without diabetes. Although MACE incidence was not affected by stent dimensions in the patients with diabetes, the nondiabetic patients implanted with a stent length exceeding 27 mm experienced MACE less frequently.
Conclusion: Diabetes did not influence MACE in our population. Additionally, stents of different sizes were not associated with MACE in patients with diabetes. We propose that using the DES supplemented by long-term DAPT and tight control of glycemic status after PCI could decrease the adverse consequences of diabetes.
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3. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO; ESC Scientific Document Group. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2019;40:87-165.
4. Kappetein AP, Head SJ, Morice MC, Banning AP, Serruys PW, Mohr FW, Dawkins KD, Mack MJ; SYNTAX Investigators. Treatment of complex coronary artery disease in patients with diabetes: 5-year results comparing outcomes of bypass surgery and percutaneous coronary intervention in the SYNTAX trial. Eur J Cardiothorac Surg 2013;43:1006-1013.
5. Fukutomi M, Takahashi M, Toriumi S, Ogoyama Y, Oba Y, Funayama H, Kario K. Evaluation of stent length on the outcome of ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention. Coron Artery Dis 2019;30:196-203.
6. Konigstein M, Ben-Yehuda O, Smits PC, Love MP, Banai S, Perlman GY, Golomb M, Ozan MO, Liu M, Leon MB, Stone GW, Kandzari DE. Outcomes Among Diabetic Patients Undergoing Percutaneous Coronary Intervention With Contemporary Drug-Eluting Stents: Analysis From the BIONICS Randomized Trial. JACC Cardiovasc Interv 2018;11:2467-2476.
7. Maeng M, Jensen LO, Tilsted HH, Kaltoft A, Kelbaek H, Abildgaard U, Villadsen A, Aarøe J, Thayssen P, Krusell LR, Christiansen EH, Bøtker HE, Kristensen SD, Ravkilde J, Madsen M, Sørensen HT, Rasmussen K, Thuesen L, Lassen JF. Outcome of sirolimus-eluting versus zotarolimus-eluting coronary stent implantation in patients with and without diabetes mellitus (a SORT OUT III Substudy). Am J Cardiol 2011;108:1232-1237.
8. ADVANCE Collaborative Group, Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, Marre M, Cooper M, Glasziou P, Grobbee D, Hamet P, Harrap S, Heller S, Liu L, Mancia G, Mogensen CE, Pan C, Poulter N, Rodgers A, Williams B, Bompoint S, de Galan BE, Joshi R, Travert F. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008;358:2560-2572.
9. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, Elkind MS, George MG, Hamdan AD, Higashida RT, Hoh BL, Janis LS, Kase CS, Kleindorfer DO, Lee JM, Moseley ME, Peterson ED, Turan TN, Valderrama AL, Vinters HV; American Heart Association Stroke Council, Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; Council on Peripheral Vascular Disease; Council on Nutrition, Physical Activity and Metabolism. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:2064-2089.
10. Ahmed A, Husain A, Love TE, Gambassi G, Dell'Italia LJ, Francis GS, Gheorghiade M, Allman RM, Meleth S, Bourge RC. Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods. Eur Heart J 2006;27:1431-1439.
11. Rawshani A, Rawshani A, Franzén S, Sattar N, Eliasson B, Svensson AM, Zethelius B, Miftaraj M, McGuire DK, Rosengren A, Gudbjörnsdottir S. Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2018;379:633-644.
12. Esper RB, Farkouh ME, Ribeiro EE, Hueb W, Domanski M, Hamza TH, Siami FS, Godoy LC, Mathew V, French J, Fuster V. SYNTAX Score in Patients With Diabetes Undergoing Coronary Revascularization in the FREEDOM Trial. J Am Coll Cardiol 2018;72(23 Pt A):2826-2837.
13. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2019. Diabetes Care 2019;42(Suppl 1):S13-S28.
14. Zibaeenezhad MJ, Mohammadi SS, Sayadi M, Khorshidi S, Bahramali E, Razeghian-Jahromi I. The impact of diabetes mellitus and hypertension on clinical outcomes in a population of Iranian patients who underwent percutaneous coronary intervention: A retrospective cohort study. J Clin Hypertens (Greenwich) 2019;21:1647-1653.
15. Nelson RH. Hyperlipidemia as a risk factor for cardiovascular disease. Prim Care 2013;40:195-211.
16. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, Jüni P, Kastrati A, Kolh P, Mauri L, Montalescot G, Neumann FJ, Petricevic M, Roffi M, Steg PG, Windecker S, Zamorano JL, Levine GN; ESC Scientific Document Group. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur J Cardiothorac Surg 2018;53:34-78.
17. Zibaeenezhad MJ, Ghaem H, Parsa N, Sayadi M, Askarian M, Kasaei M, Sohrabi Z, Dehghani-Firouzabadi A, Nariman A, Radmanesh S, Mani A, Bahramali E, Nikoo MH, Moaref AR, Razeghian-Jahromi I. Analysing cardiovascular risk factors and related outcomes in a middle-aged to older adults population in Iran: a cohort protocol of the Shiraz Heart Study (SHS). BMJ Open 2019;9:e026317.
18. Konigstein M, Ben-Yehuda O, Smits PC, Love MP, Banai S, Perlman GY, Golomb M, Ozan MO, Liu M, Leon MB, Stone GW, Kandzari DE. Outcomes Among Diabetic Patients Undergoing Percutaneous Coronary Intervention With Contemporary Drug-Eluting Stents: Analysis From the BIONICS Randomized Trial. JACC Cardiovasc Interv 2018;11:2467-2476.
19. Byrne RA, Banai S, Colleran R, Colombo A. Challenges in Patients with Diabetes: Improving Clinical Outcomes After Percutaneous Coronary Intervention Through EVOlving Stent Technology. Interv Cardiol 2018;13:40-44.
20. Messerli A, Whayne TF Jr. Impact of Diabetes Mellitus on Percutaneous Coronary Intervention Outcomes: Real-World Lessons From a Large Chinese Single-Center Registry. Angiology 2018;69:749-751.
21. Loutfi M, Sadaka MA, Sobhy M. Outcomes of DES in Diabetic and Nondiabetic Patients with Complex Coronary Artery Disease after Risk Stratification by the SYNTAX Score. Clin Med Insights Cardiol 2016;10:103-110.
22. Iijima R, Ndrepepa G, Mehilli J, Markwardt C, Bruskina O, Pache J, Ibrahim M, Schömig A, Kastrati A. Impact of diabetes mellitus on long-term outcomes in the drug-eluting stent era. Am Heart J 2007;154:688-693.
23. Osende JI, Badimon JJ, Fuster V, Herson P, Rabito P, Vidhun R, Zaman A, Rodriguez OJ, Lev EI, Rauch U, Heflt G, Fallon JT, Crandall JP. Blood thrombogenicity in type 2 diabetes mellitus patients is associated with glycemic control. J Am Coll Cardiol 2001;38:1307-1312.
24. Neergaard-Petersen S, Hvas AM, Kristensen SD, Grove EL, Larsen SB, Phoenix F, Kurdee Z, Grant PJ, Ajjan RA. The influence of type 2 diabetes on fibrin clot properties in patients with coronary artery disease. Thromb Haemost 2014;112:1142-1150.
25. Park DW, Flaherty JD, Davidson CJ, Yun SC, Lee SW, Kim YH, Lee CW, Hong MK, Cheong SS, Kim JJ, Park SW, Park SJ. Prognostic influence of diabetes mellitus on long-term clinical outcomes and stent thrombosis after drug-eluting stent implantation in asian patients. Am J Cardiol 2009;103:646-652.
26. Koskinas KC, Siontis GC, Piccolo R, Franzone A, Haynes A, Rat-Wirtzler J, Silber S, Serruys PW, Pilgrim T, Räber L, Heg D, Jüni P, Windecker S. Impact of Diabetic Status on Outcomes After Revascularization With Drug-Eluting Stents in Relation to Coronary Artery Disease Complexity: Patient-Level Pooled Analysis of 6081 Patients. Circ Cardiovasc Interv 2016;9:e003255.
27. Wang JL, Qin Z, Wang ZJ, Shi DM, Liu YY, Zhao YX, Yang LX, Cheng WJ, Zhou YJ. New predictors of in-stent restenosis in patients with diabetes mellitus undergoing percutaneous coronary intervention with drug-eluting stent. J Geriatr Cardiol 2018;15:137-145.
28. Megaly M, Ali A, Abraham B, Khalil C, Zordok M, Shaker M, Tawadros M, Hennawy BS, Elbadawi A, Omer M, Saad M. Outcomes with Drug-Coated Balloons in Percutaneous Coronary Intervention in Diabetic Patients. Cardiovasc Revasc Med 2020;21:78-85.
29. Billinger M, Räber L, Hitz S, Stefanini GG, Pilgrim T, Stettler C, Zanchin T, Pulver C, Pfäffli N, Eberli F, Meier B, Kalesan B, Jüni P, Windecker S. Long-term clinical and angiographic outcomes of diabetic patients after revascularization with early generation drug-eluting stents. Am Heart J 2012;163:876-886.
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| Files | ||
| Issue | Vol 17 No 4 (2022): J Teh Univ Heart Ctr | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v17i4.11609 | |
| Keywords | ||
| Diabetes mellitus Myocardial infarction Percutaneous coronary intervention Stents | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Zibaeenezhad MJ, Sayadi M, Mohammadi SS, Khorshidi S, Hadiyan E, Rasouli N, Karimi-Akhormeh A, Razeghian-Jahromi I. The Impact of Diabetes Mellitus on Clinical Outcomes after Percutaneous Coronary Intervention with Different Stent Sizes. J Tehran Heart Cent. 2022;17(4):207-214.
