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Impact of Diabetes on Long-Term Outcome After Primary Angioplasty: Insights from the DESERT cooperation

OBJECTIVE: Diabetes has been shown to be associated with worse survival and repeat target vessel revascularization (TVR) after primary angioplasty. The aim of the current study was to evaluate the impact of diabetes on long-term outcome in patients undergoing primary angioplasty treated with bare me...

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Autores principales: De Luca, Giuseppe, Dirksen, Maurits T., Spaulding, Christian, Kelbæk, Henning, Schalij, Martin, Thuesen, Leif, van der Hoeven, Bas, Vink, Marteen A., Kaiser, Christoph, Musto, Carmine, Chechi, Tania, Spaziani, Gaia, Diaz de la Llera, Luis Salvador, Pasceri, Vincenzo, Di Lorenzo, Emilio, Violini, Roberto, Suryapranata, Harry, Stone, Gregg W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Diabetes Association 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609523/
https://www.ncbi.nlm.nih.gov/pubmed/23275351
http://dx.doi.org/10.2337/dc12-1507
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author De Luca, Giuseppe
Dirksen, Maurits T.
Spaulding, Christian
Kelbæk, Henning
Schalij, Martin
Thuesen, Leif
van der Hoeven, Bas
Vink, Marteen A.
Kaiser, Christoph
Musto, Carmine
Chechi, Tania
Spaziani, Gaia
Diaz de la Llera, Luis Salvador
Pasceri, Vincenzo
Di Lorenzo, Emilio
Violini, Roberto
Suryapranata, Harry
Stone, Gregg W.
author_facet De Luca, Giuseppe
Dirksen, Maurits T.
Spaulding, Christian
Kelbæk, Henning
Schalij, Martin
Thuesen, Leif
van der Hoeven, Bas
Vink, Marteen A.
Kaiser, Christoph
Musto, Carmine
Chechi, Tania
Spaziani, Gaia
Diaz de la Llera, Luis Salvador
Pasceri, Vincenzo
Di Lorenzo, Emilio
Violini, Roberto
Suryapranata, Harry
Stone, Gregg W.
author_sort De Luca, Giuseppe
collection PubMed
description OBJECTIVE: Diabetes has been shown to be associated with worse survival and repeat target vessel revascularization (TVR) after primary angioplasty. The aim of the current study was to evaluate the impact of diabetes on long-term outcome in patients undergoing primary angioplasty treated with bare metal stents (BMS) and drug-eluting stents (DES). RESEARCH DESIGN AND METHODS: Our population is represented by 6,298 ST-segment elevation myocardial infarction (STEMI) patients undergoing primary angioplasty included in the DESERT database from 11 randomized trials comparing DES with BMS. RESULTS: Diabetes was observed in 972 patients (15.4%) who were older (P < 0.001), more likely to be female (P < 0.001), with higher prevalence of hypertension (P < 0.001), hypercholesterolemia (P < 0.001), and longer ischemia time (P < 0.001), and without any difference in angiographic and procedural characteristics. At long-term follow-up (1,201 ± 441 days), diabetes was associated with higher rates of death (19.1% vs. 7.4%; P < 0.0001), reinfarction (10.4% vs. 7.5%; P < 0.001), stent thrombosis (7.6% vs. 4.8%; P = 0.002) with similar temporal distribution—acute, subacute, late, and very late—between diabetic and control patients, and TVR (18.6% vs. 15.1%; P = 0.006). These results were confirmed in patients receiving BMS or DES, except for TVR, there being no difference observed between diabetic and nondiabetic patients treated with DES. The impact of diabetes on outcome was confirmed after correction for baseline confounding factors (mortality, P < 0.001; repeat myocardial infarction, P = 0.006; stent thrombosis, P = 0.007; TVR, P = 0.027). CONCLUSIONS: This study shows that among STEMI patients undergoing primary angioplasty, diabetes is associated with worse long-term mortality, reinfarction, and stent thrombosis in patients receiving DES and BMS. DES implantation, however, does mitigate the known deleterious effect of diabetes on TVR after BMS.
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spelling pubmed-36095232014-04-01 Impact of Diabetes on Long-Term Outcome After Primary Angioplasty: Insights from the DESERT cooperation De Luca, Giuseppe Dirksen, Maurits T. Spaulding, Christian Kelbæk, Henning Schalij, Martin Thuesen, Leif van der Hoeven, Bas Vink, Marteen A. Kaiser, Christoph Musto, Carmine Chechi, Tania Spaziani, Gaia Diaz de la Llera, Luis Salvador Pasceri, Vincenzo Di Lorenzo, Emilio Violini, Roberto Suryapranata, Harry Stone, Gregg W. Diabetes Care Original Research OBJECTIVE: Diabetes has been shown to be associated with worse survival and repeat target vessel revascularization (TVR) after primary angioplasty. The aim of the current study was to evaluate the impact of diabetes on long-term outcome in patients undergoing primary angioplasty treated with bare metal stents (BMS) and drug-eluting stents (DES). RESEARCH DESIGN AND METHODS: Our population is represented by 6,298 ST-segment elevation myocardial infarction (STEMI) patients undergoing primary angioplasty included in the DESERT database from 11 randomized trials comparing DES with BMS. RESULTS: Diabetes was observed in 972 patients (15.4%) who were older (P < 0.001), more likely to be female (P < 0.001), with higher prevalence of hypertension (P < 0.001), hypercholesterolemia (P < 0.001), and longer ischemia time (P < 0.001), and without any difference in angiographic and procedural characteristics. At long-term follow-up (1,201 ± 441 days), diabetes was associated with higher rates of death (19.1% vs. 7.4%; P < 0.0001), reinfarction (10.4% vs. 7.5%; P < 0.001), stent thrombosis (7.6% vs. 4.8%; P = 0.002) with similar temporal distribution—acute, subacute, late, and very late—between diabetic and control patients, and TVR (18.6% vs. 15.1%; P = 0.006). These results were confirmed in patients receiving BMS or DES, except for TVR, there being no difference observed between diabetic and nondiabetic patients treated with DES. The impact of diabetes on outcome was confirmed after correction for baseline confounding factors (mortality, P < 0.001; repeat myocardial infarction, P = 0.006; stent thrombosis, P = 0.007; TVR, P = 0.027). CONCLUSIONS: This study shows that among STEMI patients undergoing primary angioplasty, diabetes is associated with worse long-term mortality, reinfarction, and stent thrombosis in patients receiving DES and BMS. DES implantation, however, does mitigate the known deleterious effect of diabetes on TVR after BMS. American Diabetes Association 2013-04 2013-03-14 /pmc/articles/PMC3609523/ /pubmed/23275351 http://dx.doi.org/10.2337/dc12-1507 Text en © 2013 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
spellingShingle Original Research
De Luca, Giuseppe
Dirksen, Maurits T.
Spaulding, Christian
Kelbæk, Henning
Schalij, Martin
Thuesen, Leif
van der Hoeven, Bas
Vink, Marteen A.
Kaiser, Christoph
Musto, Carmine
Chechi, Tania
Spaziani, Gaia
Diaz de la Llera, Luis Salvador
Pasceri, Vincenzo
Di Lorenzo, Emilio
Violini, Roberto
Suryapranata, Harry
Stone, Gregg W.
Impact of Diabetes on Long-Term Outcome After Primary Angioplasty: Insights from the DESERT cooperation
title Impact of Diabetes on Long-Term Outcome After Primary Angioplasty: Insights from the DESERT cooperation
title_full Impact of Diabetes on Long-Term Outcome After Primary Angioplasty: Insights from the DESERT cooperation
title_fullStr Impact of Diabetes on Long-Term Outcome After Primary Angioplasty: Insights from the DESERT cooperation
title_full_unstemmed Impact of Diabetes on Long-Term Outcome After Primary Angioplasty: Insights from the DESERT cooperation
title_short Impact of Diabetes on Long-Term Outcome After Primary Angioplasty: Insights from the DESERT cooperation
title_sort impact of diabetes on long-term outcome after primary angioplasty: insights from the desert cooperation
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609523/
https://www.ncbi.nlm.nih.gov/pubmed/23275351
http://dx.doi.org/10.2337/dc12-1507
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