Transcript Drug Eluting and Bare Metal Stenting for Diabetes Mellitus

Drug Eluting and Bare Metal
Stenting for Diabetes Mellitus
Results from the Massachusetts Data
Analysis Center Registry
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
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
Methods

All PCI in Massachusetts non-federal hospitals from
April 2003 through September 2004 (excluded nonMass 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
Outcomes

Matched risk differences for mortality, MI
and TVR rates at 3 years
Patient population

Prevalence of Diabetics in patients undergoing
PCI: 28.5% (33% requiring insulin)
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)
Matched Risk Differences at 3 Yrs
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
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