Impact of drug-eluting stents on treatment of long lesions in diabetic patients

ABSTRACT

The study was designed to evaluate in-hospital and mid-term clinical outcomes of drug-eluting stents in treatment of long lesions in diabetic versus non-diabetic patients. We studied 100 diabetic and 200 non-diabetic patients with long lesions >/= 20 mm treated with either Cypher or Taxus stents. The majority of the patients were males with a mean age over sixty years in both groups. Both groups were almost matched as regards demographic and clinical characteristics. The majority of patients in both groups presented with unstable angina [49% diabetics and 46.5% non-diabetics]. The incidence of multivessel disease was higher within the diabetic population The mean lesion length in diabetic group was 34.24 +/- 13.48 mm versus 36.68 +/- 16.32 mm in non-diabetic [p=0.11]. The mean percentage of multiple stents per lesion was 40.5% in diabetic patients versus 46.6% in non-diabetic patients [p=0.16]. The in-hospital Major Adverse Cardiac Events [MACE] rate was 10% in diabetic patients versus 7.5% in non-diabetic patients [p=0.25]. Only 2 patients [0.66%] had subacute stent thrombosis while there was no late stent thrombosis. After a mean clinical follow-up period of 328 +/- 127 days, there was no statistical difference between the two groups, in terms of survival [96.88%for diabetic vs. 98.96%for non-diabetic group at 15 months, p=0.29], While the midterm clinical outcome showed higher rate of MACE in uncontrolled diabetics [23.07%] than controlled diabetics [11.36%][p=0.016]. In selected group of patients, the stenting of long lesion with DES may be a good alternative to surgery with excellent mid-term outcome. Also, diabetes mellitus in the era of Drug-Eluting Stents [DES] has limited impact on outcome after PCI in long lesions when the glycemic state is well controlled