Drug Eluting and Bare Metal Stenting for Diabetes Mellitus

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Drug Eluting and Bare Metal Stenting for Diabetes
Mellitus

• Results from the Massachusetts Data Analysis
  Center Registry

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Background

• Diabetics have a higher prevalence of ischemic
  heart disease than non-diabetics
• Diabetics have a higher incidence of restenosis,
  MI and cardiac mortality after percutaneous
  coronary intervention than non-diabetics

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Objectives

• To evaluate whether DES are associated with
  increased rates of death or MI compared with BMS
  in Diabetic patients
• To evaluate whether DES are associated with
  reduction in revascularization compared with BMS
  in the Diabetic population

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Methods

• All PCI in Massachusetts non-federal hospitals
  from April 2003 through September 2004 (excluded
  non-Mass residents and patient treated with both
  stent types)
• Clinical and procedural factors collected
  prospectively
• Mortality from hospital records, MASS registry
  and Social Security Death Index
• MI and revascularization from MASS PCI and CABG
  database and hospital records
• Propensity score matching

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Outcomes

• Matched risk differences for mortality, MI and
  TVR rates at 3 years

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Patient population

• Prevalence of Diabetics in patients undergoing
  PCI 28.5 (33 requiring insulin)

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Characteristics after match

• All variables were well-matched with the
  exception of
• GP IIb/IIIa inhibitor preadministered (22.2 in
  DES gp vs 17.6 in BMS gp)
• Elective procedure status for PCI (35.7 in DES
  gp vs 41.5 in BMS gp)

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Matched Risk Differences at 3 Yrs
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Conclusions

• In a propensity matched analysis of 2952 Diabetic
  patients treated with DES or BMS, there were
  decreased rates of death, MI, and TVR associated
  with DES at 3 years
• This population-based analysis shows preserved
  efficacy of DES with no increased hazard of death
  and MI compared with BMS in long term follow-up

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Future direction

• Evaluation of whether the reductions in death and
  MI see in the DES group is due to reduced need
  for repeat procedures, more complete
  revascularization, or longer duration of
  antiplatelet therapy