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Claudio Moretti, M.D. Division of Cardiology, University of Turin, Turin, Italy

Diabetes mellitus in patients undergoing percutaneous drug-eluting stent implantation: short and long-term results. Claudio Moretti, M.D. Division of Cardiology, University of Turin, Turin, Italy on behalf of the University of Turin Registry Investigators :

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Claudio Moretti, M.D. Division of Cardiology, University of Turin, Turin, Italy

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  1. Diabetes mellitus in patients undergoing percutaneous drug-eluting stent implantation: short and long-term results Claudio Moretti, M.D. Division of Cardiology, University of Turin, Turin, Italy on behalf of the University of TurinRegistryInvestigators: G. Longo, F. D’Ascenzo, A. Gonella, A. Pullara, G. Biondi Zoccai, F. Sciuto, P.L. Omedè, G. P. Trevi, I. Sheiban

  2. Background The introduction of drug-eluting stents (DES) has markedly improved mid-term results of percutaneous coronary intervention (PCI) in diabetics. Furthermore it is unclear whether the risk-benefit balance of DES in diabetics is maintained also at long-term and in insulin requiring patients. We aimed to appraise long-term outcomes of diabetic patients treated with PCI with DES, stratifying according to insulin therapy.

  3. Methods Patients undergoing PCI with DES from July 2002 to June 2004 at our center, and thus eligible for at least 5-year follow-up N=1277 insulin-requiring diabetics 37/1277 (3%) without diabetes 954/1277 (75%) non-insulin-requiring diabetics 275/1277 (22%)

  4. Methods The primary end-point was the long-term rate of major adverse cardiac events (MACE, ie the composite of death, myocardial infarction, or target vessel revascularization). Secondary end-points were the individual components of MACE, as well as death divided according to its etiology. We also considered stent thrombosis according to the Academic Research Consortium definitions.

  5. Clinical characteristics of patients 30% 81% 34% 75% 54% 32% There were significant differences across groups in prevalence of male gender (respectively, 32%, 81% and 75%, p<0.001), and DES usage (54%, 34% and 30%, p=0.007).

  6. Age of patients The mean age of patients is comparable in the three groups.

  7. Early clinical outcomes 30-day MACE occurred with similar frequency in the three groups (8%, 7% and 6%, p=0.78), with death in 3%, 2%, and 1% (p=0.71) and myocardial infarction in 5%, 2% and 1% (p=0.02).

  8. 30- days outcomes: causes of death

  9. Late clinical outcomes After a median follow-up period of 58 months, MACE occurred in 59% of patients with insulin-requiring diabetes, in 51% of non-insulin-requiring diabetics, and in 39% of non-diabetics (p<0.001), with death in 24%, 17% and 9% (p<0.001), myocardial infarction in 11%, 7%, and 5% (p=0.25), repeat revascularization in 46%, 32%, and 30% (p=0.11), and definite stent thrombosis occurred in in 0%, 1%, and 1% (p=0.78).

  10. Late clinical outcomes: causes of death

  11. Conclusions This long-term retrospective study emphasizes the very high risk of long-term adverse events faced by insulin requiring and non-insulin-requiring diabetics undergoing PCI with DES. Further research on additional pharmacologic treatments or hybrid revascularization strategies to mitigate their burden of morbidity and mortality is warranted.

  12. For these and further slides on these topics please feel free to visit the metcardio.org website:http://www.metcardio.org/slides.html

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