Influência dos stents farmacológicos na seleção de pacientes diabéticos tratados por meio de intervenção coronária percutânea / Influence of drug-eluting stents in the selection of diabetic pacients treated by percutaneous coronary intervention

RESUMO

Introdução: Os diabéticos representam um desafio para as intervenções coronárias percutâneas (ICP) em decorrência das elevadas taxas de reestenose, limitando a utilização desse procedimento em situações com grande perspectiva de recidiva, restringindo o emprego da técnica e predispondo à revascularização incompleta. Os stents farmacológicos contribuíram para a atenuação expressiva dessas limitações, podendo ter causado mudanças nas características dos casos tratados contemporaneamente. Assim, nosso objetivo foi comparar o perfil dos diabéticos tratados por ICP em dois momentos distintos desta década. Método: Estudo de coorte envolvendo 2.530 pacientes diabéticos revascularizados de forma consecutiva, divididos em dois grupos grupo A, 1.309 pacientes revascularizados no período de 2006 a 2008; e grupo B, 1.221 pacientes tratados entre 2003 e 2005. Excluíram-se apenas os pacientes em que foram utilizados stents farmacológicos não disponíveis para uso comercial...

ABSTRACT

Background: Diabetic patients represent a challenge for percutaneous coronary interventions (PCI) due to the highrestenosis rates, which limit the use of the procedure in cases prone to recurrences, predisposing patients to incomplete revascularization. Drug-eluting stents (DES) have contributed for a significant improvement of these limitations and may have caused changes in the characteristics of patients treated contemporaneously. Thus, our objective was to compare the profile of diabetic patients treated intwo different periods of this decade. Method: This was a consecutive cohort study including 2,530 diabetic patientswho were divided into two groups group A, 1,309 patients revascularized from 2006 to 2008; and group B, 1,221patients treated from 2003 to 2005. Only patients using DES not commercially available were excluded. Results: DES were more frequently used in group A (23% vs. 9%; P < 0.0001), which has a higher prevalence of insulin requiring patients (14% vs. 10%; P = 0.0001), chronic renal failure (20% vs. 10.1%; P < 0.0001), B2/C lesions(68% vs. 63%; P = 0.003), total occlusions (17% vs. 10%; P < 0.0001), stent diameter < 2.5 mm (26% vs. 22%; P = 0.01) and stent length > 24 mm (31% vs. 22%; P < 0.0001).Multivessel interventions (12% vs. 6%; P < 0.001) and complete revascularization (65% vs. 59%; P = 0.002) also prevailed in group A. Clinical hospital results were not different between groups. Conclusion: The greater availability of DES has led to significant changes in the profile ofdiabetic patients treated currently, expanding the indications for more complex patients and providing a more complete myocardial revascularization.