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Influence of Diabetes Mellitus on Long-Term (Five-Year) Outcomes of Drug-Eluting Stents and Coronary Artery Bypass Grafting for Multivessel Coronary Revascularization

      Diabetes mellitus is a major risk factor for coronary artery disease (CAD) and for diffuse and progressive atherosclerosis. We evaluated the outcomes of drug-eluting stent (DES) placement and coronary artery bypass grafting (CABG) in 891 diabetic patients (489 for DES implantation and 402 for CABG) and 2,151 nondiabetic patients (1,058 for DES implantation and 1,093 for CABG) with multivessel CAD treated from January 2003 through December 2005 and followed up for a median 5.6 years. Outcomes of interest included death; the composite outcome of death, myocardial infarction (MI), or stroke; and repeat revascularization. In diabetic patients, after adjusting for baseline covariates, 5-year risk of death (hazard ratio 1.01, 95% confidence interval 0.77 to 1.33, p = 0.96) and the composite of death, MI, or stroke (hazard ratio 1.03, 95% confidence interval 0.80 to 1.31, p = 0.91) were similar in patients undergoing DES or CABG. However, rate of repeat revascularization was significantly higher in the DES group (hazard ratio 3.69, 95% confidence interval 2.64 to 5.17, p <0.001). These trends were consistent in nondiabetic patients (hazard ratio 0.80, 95% confidence interval 0.55 to 1.16, p = 0.23 for death; hazard ratio 0.77, 95% confidence interval 0.56 to 1.05, p = 0.10 for composite of death, MI, or stroke; hazard ratio 2.77, 95% CI 1.95 to 3.91, p <0.001 for repeat revascularization). There was no significant interaction between diabetic status and treatment strategy on clinical outcomes (p for interaction = 0.36 for death; 0.20 for the composite of death, MI, or stroke; and 0.40 for repeat revascularization). In conclusion, there was no significant prognostic influence of diabetes on long-term treatment with DES or CABG in patients with multivessel CAD.
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      References

        • Kannel W.B.
        • McGee D.L.
        Diabetes and cardiovascular disease.
        JAMA. 1979; 241: 2035-2038
        • Hammoud T.
        • Tanguay J.F.
        • Bourassa M.G.
        Management of coronary artery disease: therapeutic options in patients with diabetes.
        J Am Coll Cardiol. 2000; 36: 355-365
        • Stein B.
        • Weintraub W.S.
        • Gebhart S.P.
        • Cohen-Bernstein C.L.
        • Grosswald R.
        • Liberman H.A.
        • Douglas Jr, J.S.
        • Morris D.C.
        • King III, S.B.
        Influence of diabetes mellitus on early and late outcome after percutaneous transluminal coronary angioplasty.
        Circulation. 1995; 91: 979-989
        • Kip K.E.
        • Faxon D.P.
        • Detre K.M.
        • Yeh W.
        • Kelsey S.F.
        • Currier J.W.
        Coronary angioplasty in diabetic patients.
        Circulation. 1996; 94: 1818-1825
        • Elezi S.
        • Kastrati A.
        • Pache J.
        • Wehinger A.
        • Hadamitzky M.
        • Dirschinger J.
        • Neumann F.J.
        • Schömig A.
        Diabetes mellitus and the clinical and angiographic outcome after coronary stent placement.
        J Am Coll Cardiol. 1998; 32: 1866-1873
        • Thourani V.H.
        • Weintraub W.S.
        • Stein B.
        • Gebhart S.S.
        • Craver J.M.
        • Jones E.L.
        • Guyton R.A.
        Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting.
        Ann Thorac Surg. 1999; 67: 1045-1052
        • Mehran R.
        • Dangas G.D.
        • Kobayashi Y.
        • Lansky A.J.
        • Mintz G.S.
        • Aymong E.D.
        • Fahy M.
        • Moses J.W.
        • Stone G.W.
        • Leon M.B.
        Short- and long-term results after multivessel stenting in diabetic patients.
        J Am Coll Cardiol. 2004; 43: 1348-1354
        • West N.E.
        • Ruygrok P.N.
        • Disco C.M.
        • Webster M.W.
        • Lindeboom W.K.
        • O'Neill W.W.
        • Mercado N.F.
        • Serruys P.W.
        Clinical and angiographic predictors of restenosis after stent deployment in diabetic patients.
        Circulation. 2004; 109: 867-873
        • The Bypass Angioplasty Revascularization Investigation (BARI) investigators
        Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease.
        N Engl J Med. 1996; 335: 217-225
        • Hlatky M.A.
        • Boothroyd D.B.
        • Bravata D.M.
        • Boersma E.
        • Booth J.
        • Brooks M.M.
        • Carrié D.
        • Clayton T.C.
        • Danchin N.
        • Flather M.
        • Hamm C.W.
        • Hueb W.A.
        • Kähler J.
        • Kelsey S.F.
        • King S.B.
        • Kosinski A.S.
        • Lopes N.
        • McDonald K.M.
        • Rodriguez A.
        • Serruys P.
        • Sigwart U.
        • Stables R.H.
        • Owens D.K.
        • Pocock S.J.
        Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials.
        Lancet. 2009; 373: 1190-1197
        • Stettler C.
        • Allemann S.
        • Wandel S.
        • Kastrati A.
        • Morice M.C.
        • Schömig A.
        • Pfisterer M.E.
        • Stone G.W.
        • Leon M.B.
        • de Lezo J.S.
        • Goy J.J.
        • Park S.J.
        • Sabaté M.
        • Suttorp M.J.
        • Kelbaek H.
        • Spaulding C.
        • Menichelli M.
        • Vermeersch P.
        • Dirksen M.T.
        • Cervinka P.
        • De Carlo M.
        • Erglis A.
        • Chechi T.
        • Ortolani P.
        • Schalij M.J.
        • Diem P.
        • Meier B.
        • Windecker S.
        • Jüni P.
        Drug eluting and bare metal stents in people with and without diabetes: collaborative network meta-analysis.
        BMJ. 2008; 337: a1331
        • Park D.W.
        • Kim Y.H.
        • Song H.G.
        • Ahn J.M.
        • Oh J.
        • Kim W.J.
        • Lee J.Y.
        • Kang S.J.
        • Lee S.W.
        • Lee C.W.
        • Park S.W.
        • Yun S.C.
        • Jung S.H.
        • Choo S.J.
        • Chung C.H.
        • Lee J.W.
        • Park S.J.
        Long-term comparison of drug-eluting stents and coronary artery bypass grafting for multivessel coronary revascularization: 5-year outcomes from the Asan Medical Center-Multivessel Revascularization registry.
        J Am Coll Cardiol. 2011; 57: 128-137
        • Hannan E.L.
        • Wu C.
        • Walford G.
        • Culliford A.T.
        • Gold J.P.
        • Smith C.R.
        • Higgins R.S.
        • Carlson R.E.
        • Jones R.H.
        Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease.
        N Engl J Med. 2008; 358: 331-341
        • Laskey W.K.
        • Yancy C.W.
        • Maisel W.H.
        Thrombosis in coronary drug-eluting stents: report from the meeting of the Circulatory System Medical Devices Advisory Panel of the Food and Drug Administration Center for Devices and Radiologic Health, December 7–8, 2006.
        Circulation. 2007; 115: 2352-2357
        • Robins J.M.
        • Hernán M.A.
        • Brumback B.
        Marginal structural models and causal inference in epidemiology.
        Epidemiology. 2000; 11: 550-560
        • Serruys P.W.
        • Morice M.C.
        • Kappetein A.P.
        • Colombo A.
        • Holmes D.R.
        • Mack M.J.
        • Ståhle E.
        • Feldman T.E.
        • van den Brand M.
        • Bass E.J.
        • Van Dyck N.
        • Leadley K.
        • Dawkins K.D.
        • Mohr F.W.
        • SYNTAX Investigators
        Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.
        N Engl J Med. 2009; 360: 961-972
        • Abizaid A.
        • Costa M.A.
        • Centemero M.
        • Abizaid A.S.
        • Legrand V.M.
        • Limet R.V.
        • Schuler G.
        • Mohr F.W.
        • Lindeboom W.
        • Sousa A.G.
        • Sousa J.E.
        • van Hout B.
        • Hugenholtz P.G.
        • Unger F.
        • Serruys P.W.
        • Arterial Revascularization Therapy Study Group
        Clinical and economic impact of diabetes mellitus on percutaneous and surgical treatment of multivessel coronary disease patients: insights from the Arterial Revascularization Therapy Study (ARTS) Trial.
        Circulation. 2001; 104: 533-538
        • Hong S.J.
        • Kim M.H.
        • Ahn T.H.
        • Ahn Y.K.
        • Bae J.H.
        • Shim W.J.
        • Ro Y.M.
        • Lim D.S.
        Multiple predictors of coronary restenosis after drug-eluting stent implantation in patients with diabetes.
        Heart. 2006; 92: 1119-1124
        • 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
        • Billinger M.
        • Beutler J.
        • Taghetchian K.R.
        • Remondino A.
        • Wenaweser P.
        • Cook S.
        • Togni M.
        • Seiler C.
        • Stettler C.
        • Eberli F.R.
        • Lüscher T.F.
        • Wandel S.
        • Jüni P.
        • Meier B.
        • Windecker S.
        Two-year clinical outcome after implantation of sirolimus-eluting and paclitaxel-eluting stents in diabetic patients.
        Eur Heart J. 2008; 29: 718-725
        • Carson J.L.
        • Scholz P.M.
        • Chen A.Y.
        • Peterson E.D.
        • Gold J.
        • Schneider S.H.
        Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery.
        J Am Coll Cardiol. 2002; 40: 418-423
        • Sabik III, J.F.
        • Blackstone E.H.
        • Gillinov A.M.
        • Smedira N.G.
        • Lytle B.W.
        Occurrence and risk factors for reintervention after coronary artery bypass grafting.
        Circulation. 2006; 114: I454-I460
        • Wit M.A.
        • de Mulder M.
        • Jansen E.K.
        • Umans V.A.
        Diabetes mellitus and its impact on long-term outcomes after coronary artery bypass graft surgery.
        Acta Diabetol. 2010; ([Epub ahead of print])
        • Banning A.P.
        • Westaby S.
        • Morice M.C.
        • Kappetein A.P.
        • Mohr F.W.
        • Berti S.
        • Glauber M.
        • Kellett M.A.
        • Kramer R.S.
        • Leadley K.
        • Dawkins K.D.
        • Serruys P.W.
        Diabetic and nondiabetic patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents.
        J Am Coll Cardiol. 2010; 55: 1067-1075
        • Kapur A.
        • Hall R.J.
        • Malik I.S.
        • Qureshi A.C.
        • Butts J.
        • de Belder M.
        • Baumbach A.
        • Angelini G.
        • de Belder A.
        • Oldroyd K.G.
        • Flather M.
        • Roughton M.
        • Nihoyannopoulos P.
        • Bagger J.P.
        • Morgan K.
        • Beatt K.J.
        Randomized comparison of percutaneous coronary intervention with coronary artery bypass grafting in diabetic patients.
        J Am Coll Cardiol. 2010; 55: 432-440
        • Lee M.S.
        • Yang T.
        • Dhoot J.
        • Iqbal Z.
        • Liao H.
        Meta-analysis of studies comparing coronary artery bypass grafting with drug-eluting stenting in patients with diabetes mellitus and multivessel coronary artery disease.
        Am J Cardiol. 2010; 105: 1540-1544
        • Daemen J.
        • Wenaweser P.
        • Tsuchida K.
        • Abrecht L.
        • Vaina S.
        • Morger C.
        • Kukreja N.
        • Jüni P.
        • Sianos G.
        • Hellige G.
        • van Domburg R.T.
        • Hess O.M.
        • Boersma E.
        • Meier B.
        • Windecker S.
        • Serruys P.W.
        Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study.
        Lancet. 2007; 369: 667-678
        • Lagerqvist B.
        • James S.K.
        • Stenestrand U.
        • Lindbäck J.
        • Nilsson T.
        • Wallentin L.
        • SCAAR Study Group
        Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden.
        N Engl J Med. 2007; 356: 1009-1019