| Background A series of researches had confirmed that diabetes mellitus (DM) was an independent risk factor for progression of coronary heart disease(CHD).CHD patients with DM had worse prognosis than those without DM. Percutaneous coronary intervention (PCI) with stenting has been well-developed into routine treatment for CHD patients since 1986.And about a quarter of patients undergoing PCI were associated with DM. In recent years, many studies had shown that diabetic patients had a greater risk than non-diabetic patients of restenosis, stent thrombosis, myocardial infarction and death after stent implantation. It was also researched that drug-eluting stent (DES) had reduced the risk of target lesion revascularization, myocardial infarction and death of diabetic patients than bare metal stents(BMS).This study was to evaluate the therapeutic effect of PCI with stenting on patients with and without DM by retrospectively analyzing clinical data and outcomes of patients in our department.Objective 1)to analyze the characteristics of coronary artery disease of diabetic and non-diabetic patients.2) to evaluate the therapeutic effect of stent implantation on patients with and without DM.Methods This analysis enrolled 326 patients who had received PCI with DES at the General Hospital of Nanjing Military. Of all patients involved, ninety were associated with DM and the others were non-diabetic. A comparison of clinical data and outcomes in diabetic patients versus non-diabetic patients was made. The outcomes included angina, readmission, restenosis, revascularization, myocardial infarction and cardiac death.Results 1) Diabetic patients had a higher proportion of hypertension(83.3% vs 64.0%,p=0.001).There was no difference in average age, triglyceride(TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol(LDL-C), left ventricular ejection fraction (LVEF), and rate of male, smoking, prior PCI, prior MI, prior CABG,and acute myocardial infarction(AMI) between diabetic and non-diabetic patients.2) Diabetic patients had a higher proportion of triple vessel disease (73.3% vs 58.5,p=0.013), diffuse lesion (28.9% vs 14.0%,p=0.002) and had higher Gensini score(68.0±44.7 vs 39.3±29.5,p=0.004) than non-diabetic patients. Diabetic patients had large number of lesions (4.9±2.1 vs 3.6±1.8, p=0.000) and more stents used (2.21±1.3 vs 1.82±1.1, p=0.007) than non-diabetic patients. There was no significant difference in stent length, stent diameter, and rate of calcification, thrombosis and chronic total occlusion (CTO).3) All patients enrolled were followed up for 6 to 18 months. There was no significant short-term (1 month) disadvantage regarding angina, readmission or revascularization associated with and without DM. But the long-term outcomes showed that diabetic patients had a higher rate of angina (48.9% vs 34.3%, p=0.016) and MI (2.2% vs 0%, p=0.022).The rate of restenosis, revascularization and cardiac death didn’t differed in patients with and without DM.4) Logistic regression showed that the presence of diabetes was an independent predictor of angina after PCI with DES(OR,2.10;95%CI,1.186-3.407;p<0.01).Conclusions CHD patients with DM had worse coronary artery disease, including more lesions, more triple vessel disease and more diffuse lesions. Diabetic patients could enjoy short-term PCI outcomes similar to non-diabetic patients. Although DM was an independent predictor of angina after PCI with DES, there was no difference in rate of revascularization,restenosis and mortality between patients with and without DM. In summary, DES was also safe and effective to diabetic patients. |
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