TY - JOUR
T1 - Outcomes in Patients with Diabetes Mellitus Undergoing Percutaneous Coronary Intervention in the Current Era
T2 - A Report from the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) Trial
AU - Mathew, Verghese
AU - Gersh, Bernard J.
AU - Williams, Brent A.
AU - Laskey, Warren K.
AU - Willerson, James T.
AU - Tilbury, R. Thomas
AU - Davis, Barry R.
AU - Holmes, David R.
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2004/2/3
Y1 - 2004/2/3
N2 - Background-Diabetes portends an adverse prognosis in patients undergoing percutaneous coronary intervention (PCI). Whether improvements in current clinical practice (stents, IIb/IIIa antagonists) have resulted in substantial improvement of these outcomes remains an issue. The aim of this study was to determine the influence of diabetes on 9-month outcomes of patients undergoing PCI in the current era. Methods and Results-The 11 482 patients enrolled in the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) Trial were stratified according to the presence (n=2694) or absence (n=8798) of diabetes. Diabetic patients were older; were more likely to be female; had a higher proportion of congestive failure, hypertension, prior CABG, and unstable angina; and had higher body mass index and lower ejection fraction than nondiabetic patients (P<0.01 for all comparisons). The degree of multivessel disease was similar between the two groups. American College of Cardiology/American Heart Association type C lesions were more common in diabetic patients (17% versus 15%, P<0.01). Angiographic and procedural success rates and in-hospital events were similar between the two groups. The primary end point of death, myocardial infarction, or target vessel revascularization (TVR) was analyzed as time-to-first event within 9 months of the index PCI. After adjusting for certain baseline characteristics, diabetes was independently associated with death at 9 months (relative risk [RR], 1.87; 95% CI, 1.31 to 2.68, P<0.01) and with an increased likelihood of TVR (RR, 1.27; 95% CI, 1.14 to 1.42, P<0.01), as well as the composite end point death/myocardial infartion/TVR (RR, 1.26; 95% CI, 1.13 to 1.40, P<0.01). Conclusions-Despite advances in interventional techniques, diabetes remains a significant independent predictor of adverse events in the intermediate term after PCI.
AB - Background-Diabetes portends an adverse prognosis in patients undergoing percutaneous coronary intervention (PCI). Whether improvements in current clinical practice (stents, IIb/IIIa antagonists) have resulted in substantial improvement of these outcomes remains an issue. The aim of this study was to determine the influence of diabetes on 9-month outcomes of patients undergoing PCI in the current era. Methods and Results-The 11 482 patients enrolled in the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) Trial were stratified according to the presence (n=2694) or absence (n=8798) of diabetes. Diabetic patients were older; were more likely to be female; had a higher proportion of congestive failure, hypertension, prior CABG, and unstable angina; and had higher body mass index and lower ejection fraction than nondiabetic patients (P<0.01 for all comparisons). The degree of multivessel disease was similar between the two groups. American College of Cardiology/American Heart Association type C lesions were more common in diabetic patients (17% versus 15%, P<0.01). Angiographic and procedural success rates and in-hospital events were similar between the two groups. The primary end point of death, myocardial infarction, or target vessel revascularization (TVR) was analyzed as time-to-first event within 9 months of the index PCI. After adjusting for certain baseline characteristics, diabetes was independently associated with death at 9 months (relative risk [RR], 1.87; 95% CI, 1.31 to 2.68, P<0.01) and with an increased likelihood of TVR (RR, 1.27; 95% CI, 1.14 to 1.42, P<0.01), as well as the composite end point death/myocardial infartion/TVR (RR, 1.26; 95% CI, 1.13 to 1.40, P<0.01). Conclusions-Despite advances in interventional techniques, diabetes remains a significant independent predictor of adverse events in the intermediate term after PCI.
KW - Coronary disease
KW - Diabetes mellitus
KW - Revascularization
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U2 - 10.1161/01.CIR.0000109693.64957.20
DO - 10.1161/01.CIR.0000109693.64957.20
M3 - Article
C2 - 14732749
AN - SCOPUS:0842285794
SN - 0009-7322
VL - 109
SP - 476
EP - 480
JO - Circulation
JF - Circulation
IS - 4
ER -