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Impact of diabetes on long-term outcome after primary angioplasty: Insights from the DESERT cooperation

机译：糖尿病对原发性血管成形术后长期结果的影响：沙漠合作的见解

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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 STsegment 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 distributiondacute, subacute, late, and very latedbetween 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. ? 2013 by the American Diabetes Association.
机译：目的 - 糖尿病已被证明与原发性血管成形术后的存活率更差和重复靶血管血运重建（TVR）相关。目前研究的目的是评估糖尿病对经受裸金属支架（BMS）和药物洗脱支架（DES）进行一次血管成形术患者的长期结果的影响。研究设计和方法 - 我们的人口由6,298个分段抬高心肌梗死（STEMI）患者从11例随机试验中包含在沙漠数据库中的主要血管成形术患者。结果 - 糖尿病在972名患者（15.4％）较大（P <0.001），更可能是雌性（P <0.001），高血压患病率较高（P <0.001），高胆固醇血症（P <0.001），较长的缺血时间（p <0.001），血管造影和程序特征没有任何差异。在长期随访（1,201次441天），糖尿病与较高的死亡率相关（19.1％vs.7.4％; p <0.0001），重新屈曲（10.4％vs.7.5％; p <0.001），支架血栓形成（7.6％vs.4.8％; p = 0.002），具有相似的时间分布，亚急性，晚期，非常合计糖尿病和对照患者，以及TVR（18.6％与15.1％; P = 0.006）。在接受BMS或DES的患者中证实了这些结果，除了TVR，糖尿病和非糖尿病患者之间没有观察到DES。在基线混杂因子校正后确认糖尿病对结果的影响（死亡率，P <0.001;重复心肌梗死，P = 0.006;支架血栓形成，P = 0.007; TVR，P = 0.027）。结论 - 本研究表明，在接受原发性血管成形术的STEMI患者中，糖尿病与接受DES和BMS的患者的长期死亡率，再损伤和支架血栓形成有关。然而，在BMS之后，DES植入确实减轻了糖尿病对TVR的已知有害影响。还是2013年由美国糖尿病协会。

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  • 来源
    《Diabetes care》 |2013年第4期|共6页
  • 作者

    DeLucaG.; DirksenM.T.; SpauldingC.; Kelb?kH.; SchalijM.; ThuesenL.; VanDerHoevenB.; VinkM.A.; KaiserC.; MustoC.; ChechiT.; SpazianiG.; DeLaLleraL.S.D.; PasceriV.; DiLorenzoE.; VioliniR.; SuryapranataH.; StoneG.W.;

  • 作者单位

    Division of Cardiology Ospedale Maggiore della Carità Eastern Piedmont University Novara Italy;

    Department of Interventional Cardiology Onze Lieve Vrouwe Gasthuis Amsterdam Netherlands;

    Publique-Hopitaux de Paris Cochin Hospital Paris 5 Medical School Rene Descartes University;

    Heart Center Rigshospitalet Copenhagen Denmark;

    Department of Cardiology Leiden University Medical Center Leiden Netherlands;

    Cardiac Department Skejby Hospital Skejby Denmark;

    Department of Cardiology Leiden University Medical Center Leiden Netherlands;

    Department of Interventional Cardiology Onze Lieve Vrouwe Gasthuis Amsterdam Netherlands;

    Division of Cardiology San Camillo Hospital Rome Italy;

    Division of Cardiology San Camillo Hospital Rome Italy;

    Ospedale Santa Maria Annunziata Bagno A Ripoli Florence Italy;

    Ospedale Santa Maria Annunziata Bagno A Ripoli Florence Italy;

    Hemodynamics and Interventional Cardiology Unit University Hospital Virgen del Rocio Seville;

    Interventional Cardiology Unit San Filippo Neri Hospital Rome Italy;

    Division of Cardiology S.G. Moscati Avellino Italy;

    Department of Cardiology University Hospital Basel Switzerland;

    Department of Cardiology UMCSt Radboud Nijmegen Netherlands;

    Columbia University Medical Center Cardiovascular Research Foundation New York City NY United;

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  • 正文语种 eng
  • 中图分类 内分泌腺疾病及代谢病;
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