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Drug Eluting and Bare Metal Stenting for Diabetes Mellitus

Drug Eluting and Bare Metal Stenting for Diabetes Mellitus. Results from the Massachusetts Data Analysis Center Registry. Background . Diabetics have a higher prevalence of ischemic heart disease than non-diabetics

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Drug Eluting and Bare Metal Stenting for Diabetes Mellitus

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  1. Drug Eluting and Bare Metal Stenting for Diabetes Mellitus Results from the Massachusetts Data Analysis Center Registry

  2. Background • Diabetics have a higher prevalence of ischemic heart disease than non-diabetics • Diabetics have a higher incidence of restenosis, MI and cardiac mortality after percutaneous coronary intervention than non-diabetics

  3. Objectives • To evaluate whether DES are associated with increased rates of death or MI compared with BMS in Diabetic patients • To evaluate whether DES are associated with reduction in revascularization compared with BMS in the Diabetic population

  4. Methods • All PCI in Massachusetts non-federal hospitals from April 2003 through September 2004 (excluded non-Mass residents and patient treated with both stent types) • Clinical and procedural factors collected prospectively • Mortality from hospital records, MASS registry and Social Security Death Index • MI and revascularization from MASS PCI and CABG database and hospital records • Propensity score matching

  5. Outcomes • Matched risk differences for mortality, MI and TVR rates at 3 years

  6. Patient population • Prevalence of Diabetics in patients undergoing PCI: 28.5% (33% requiring insulin)

  7. Characteristics after match • All variables were well-matched with the exception of : • GP IIb/IIIa inhibitor preadministered (22.2% in DES gp vs 17.6% in BMS gp) • Elective procedure status for PCI (35.7% in DES gp vs 41.5% in BMS gp)

  8. Matched Risk Differences at 3 Yrs

  9. Conclusions • In a propensity matched analysis of 2952 Diabetic patients treated with DES or BMS, there were decreased rates of death, MI, and TVR associated with DES at 3 years • This population-based analysis shows preserved efficacy of DES with no increased hazard of death and MI compared with BMS in long term follow-up

  10. Future direction • Evaluation of whether the reductions in death and MI see in the DES group is due to reduced need for repeat procedures, more complete revascularization, or longer duration of antiplatelet therapy

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