Evolução tardia após intervenção coronária percutânea com stents farmacológicos em pacientes diabéticos do Registro DESIRE (Drug-Eluting Stents in the Real World) / Long-Term results after percutaneous coronary intervention with drug eluting stents in diabetic patients in the DESIRE (Drug-Eluting Stents in the Real World)

RESUMO

Fundamentos: O diabetes melito está relacionado à ocorrência de desfechos desfavoráveis após intervenções coronárias percutâneas. Os stents farmacológicos podem conferir melhor evolução tardia a esse subgrupo de pacientes. O objetivo deste estudo foi avaliar o desempenho desses instrumentais em pacientes diabéticos. Métodos: O DESIRE é um registro unicêntrico, prospectivo, que inclui 2,365 pacientes tratados consecutivamente com stents farmacológicos, entre maio de 2002 e janeiro de 2008. Para a presente análise foram excluídos pacientes com diagnóstico de infarto do miocárdio, aqueles com lesão tratada em ponte de safena e os com período de evolução inferior a 6 meses. Resultados: Assim 1.705 pacientes foram divididos em dois grupos: não-diabéticos (n igual 1.211 pacientes, 71,1 por cento) e diabéticos (n igual 494 pacientes, 28,9 por cento),sendo 109 (6,4 por cento) pacientes em uso de insulina. Dentre os diabéticos havia mais idosos (64,8 mais ou menos 9,8 anos vs. 63,4 mais ou menos11,7 anos; p igual 0,025), mulheres (28,9 por cento vs. 22,5 por cento; p igual 0,005), obesos (35,2 por cento vs. 23,5 por cento; p menor 0,001)...

ABSTRACT

Background: Diabetes mellitus is related to the occurrence of unfavorable outcomes after percutaneous coronary interventions. Drug-eluting stents can confer a better late evolution to this subgroup. The aim of this study was to assess the performance of these devices in diabetic patients. Methods: The DESIRE is a single-center, prospective registry that included 2,365 consecutive patients treated with drug-eluting stents between May 2002 and January 2008. For the present analysis, patients with a diagnosis of acute myocardial infarction, those with saphenous vein grafts lesions and those within 6 months of the index procedure, were excluded. Results: Therefore, 1,705 patients were divided into two groups: non-diabetics (n = 1,211 P/71.1%) and diabetics (n = 494 P/28.9%), of which 109 P (6.4%) were insulin-dependent. Among the diabetics there was a higher number of older people (64.8 ± 9.8 years old vs. 63.4 ± 11.7 years old; p = 0.025), females (28.9 vs. 22.5%; p = 0.005), patients with obesity (35.2 vs. 23.5%; p < 0.001), hypertension (86.6 vs. 73.7%; p < 0.001), multi-vessel disease (63.4 vs. 54.4%; p = 0.001), small-vessel disease (2.70 ± 0.51 mm vs. 2.75 ± 0.42 mm; p < 0.001) and calcified lesions (32.3 vs. 27.1%; p = 0.009).In the late clinical follow up (2.2 ± 1.1 years), the combined cardiac events occurred more frequently in the diabetic patients (9.8 vs. 7.0%; p = 0.048). The multivariate analysis showed that diabetes mellitus (OR = 1.45; 95% confidence interval 1.0 to 2.1) and the presence of a calcified lesion