The influence of diabetes mellitus on the procedural and in-hospital outcomes after selective percutaneous coronary intervention
Li, C.-j.; Gao, R.-l.; Chen, J.-l.; Yang, Y.-j.; Qin, X.-w.; Xu, B.; Qiao, S.-b.; Yuan, J.-q.; Wu, Y.-j.; Liu, H.-b.; Yao, M.; Chen, J.; Dai, J.; Chen, Z.-j.
Zhonghua Xin Xue Guan Bing Za Zhi 33(3): 216-220
2005
ISSN/ISBN: 0253-3758 PMID: 15929812 Document Number: 590030
To evaluate the immediate and long-term outcomes of unprotected left main coronary artery (LMCA) stenting in Chinese patients and to approach the factors affecting the outcomes. This was a multicenter retrospective registry study. From May 1997 to March 2003 all patients in 23 hospitals undergone elective unprotected LMCA stenting with bare metal stents were enrolled into the registry. All patients enrolled were filled in a Case Report Form. 224 patients were enrolled into the registry, including 166 male (74.1%) and 58 female (25.9%), with mean age of 60.1 +/- 12.0 (22 - 88) years. There were 53 cases (23.7%) with prior myocardial infarction (MI) and 45 cases (20.1%) with diabetes mellitus. Isolated LMCA stenosis was in 126 cases (56.2%) and combined with multivessel disease in 98 cases (43.8%). Mean left ventricular EF was 63.9% +/- 12.3%. Stents were successfully implanted into LMCA in 223 cases (99.6%) and into non-LMCA in 91 cases (92.9%). In-hospital death developed in 1 case (0.45%), now-Q wave MI in 1 case (0.45%). The patients were followed up to 15.6 +/- 12.3 months. Death developed in 12 cases (5.4%), including cardiac death in 10 cases (4.5%) and non-cardiac death in 2 cases (0.9%), MI in 4 cases (1.8%), TLR of LMCA in 26 cases (11.7%) and accumulated MACE in 36 cases (16.1%). LVEF < 40%, female and LMCA combined with multivessel disease increased mortality, combined multivessel diseases with incomplete revascularization increased MACE. Logistic regression analysis revealed that LVEF < 40% and female were independent predictors of cardiac death and MACE. Follow-up angiography was performed in 102 cases (45.7%). The binary restenosis rate was 31.4% (in 32 cases). Stenting for selected patients with unprotected LMCA stenosis is feasible and safe. Currently, unprotected LMCA stenting should be performed in patients with LVEF >or= 40% and isolated LMCA disease or LMCA combined with multivessel diseases in whom complete revascularization could be obtained or inoperable patients. To compare the procedural and in-hospital outcomes in a large series of diabetic and non-diabetic patients undergoing selective percutaneous coronary intervention (PCI) and to evaluate the influence of diabetes mellitus on the procedural and in-hospital outcomes. 1294 consecutive patients underwent selective PCI from January to December 2002 in this institution were analyzed retrospectively. Baseline clinical, in-lab and in-hospital outcome information were recorded. Rates of procedural success, device success and clinical success were analyzed and logistic regression was performed to model the association between diabetes status and outcomes. Two hundred and sixty-nine patients (20.8%) complicated with diabetes. Type C lesion, double and triple vessel diseases were more prevalent in diabetics than those in non-diabetics. The pre-PCI diameter stenosis of diabetics was significantly more severe than that of non-diabetics (91.00 +/- 6.62 vs 89.81 +/- 6.64, P < 0.01). The balloon length, maximum balloon diameter and maximum balloon inflation pressure, maximum inflation duration were larger in diabetics than those in non-diabetics [(17.07 +/- 6.31) mm vs (16.07 +/- 7.28) mm, (2.30 +/- 1.11) mm vs (2.12 +/- 0.94) mm, (9.86 +/- 4.40) atm vs (9.05 +/- 4.75) atm, (20.94 +/- 14.69) s vs (18.26 +/- 14.65) s, respectively, P < 0.05]. The stent diameter was smaller in diabetics than that in non-diabetics [(3.15 +/- 0.47) mm vs (3.23 +/- 0.43) mm, P < 0.05]. The procedural success rate showed no significant difference between two groups (89.6% vs 90.3%, P > 0.05). But a higher incidence of acute/subacute stent thrombosis was observed in diabetics compared with that in non-diabetics (1.9% vs 0.5%, P < 0.05). The rate of clinical success was similar between diabetics and non-diabetics (99.3% vs 99.2%, P > 0.05). Diabetes was not an independent predictor of acute outcomes in the regression model. A higher incidence of acute/subacute stent thrombosis was observed in diabetics. The incidence of procedural and in-hospital major adverse cardiac events and the rate of clinical success were similar between diabetics and non-diabetics. Diabetes was not an independent predictor of in-hospital outcomes after selective PCI.