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Safety and efficacy of drug-eluting vs. bare metal stents in patients with diabetes mellitus: long-term follow-up in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)

Stenestrand, Ulf; James, Stefan K.; Lindback, Johan; Frobert, Ole; Carlsson, Jorg; Scherstén, Fredrik LU ; Nilsson, Tage and Lagerqvist, Bo (2010) In European Heart Journal 31(2). p.177-186
Abstract
Patients with diabetes mellitus have more extensive coronary artery disease, more disease progression, and restenosis. The use of drug-eluting stents (DES) in these patients is widespread, despite uncertain long-term safety and efficacy. All consecutive patients with diabetes mellitus in Sweden who underwent percutaneous coronary intervention were entered into the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) during 2003-06 with complete follow-up for 1-4 years (median 2.5). Patients who received at least one DES (n = 4754) were compared with those who received only bare metal stents (BMS) (n = 4956) at the index procedure. Combined outcome of death or myocardial infarction (MI) showed no difference for DES vs. BMS,... (More)
Patients with diabetes mellitus have more extensive coronary artery disease, more disease progression, and restenosis. The use of drug-eluting stents (DES) in these patients is widespread, despite uncertain long-term safety and efficacy. All consecutive patients with diabetes mellitus in Sweden who underwent percutaneous coronary intervention were entered into the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) during 2003-06 with complete follow-up for 1-4 years (median 2.5). Patients who received at least one DES (n = 4754) were compared with those who received only bare metal stents (BMS) (n = 4956) at the index procedure. Combined outcome of death or myocardial infarction (MI) showed no difference for DES vs. BMS, relative risk (RR), 0.91 [95% confidence interval (CI), 0.77-1.06]. Myocardial infarction was significantly less common with DES in patients who received only one stent RR, 0.80 (95% CI, 0.66-0.96). The restenosis rate was 50% lower in DES-treated patients RR, 0.50 (95% CI, 0.35-0.70) and was associated with a higher adjusted RR of MI, RR, 5.03 (95% CI, 4.25-5.97). DES was associated with reduced restenosis rates in all subgroups of diabetic patients with the greatest benefit in stent diameters < 3 mm or stent length > 20 mm. The number of lesions treated with DES to prevent one restenosis ranged from 11 to 47 in various subgroups. This real-life registry study shows that restenosis was halved by DES in diabetic patients with stable or unstable coronary disease, with similar risk of death or MI up to 4 years compared with BMS. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Percutaneous coronary intervention, Revascularization, Drug-eluting stent, Mortality, Diabetes mellitus, Outcome, Myocardial infarction
in
European Heart Journal
volume
31
issue
2
pages
177 - 186
publisher
Oxford University Press
external identifiers
  • wos:000273700600014
  • scopus:74549191936
ISSN
1522-9645
DOI
10.1093/eurheartj/ehp424
language
English
LU publication?
yes
id
45bee6ba-0098-4b23-9cd5-dd763fdabf3b (old id 1547535)
date added to LUP
2010-02-23 13:55:25
date last changed
2018-05-29 11:45:58
@article{45bee6ba-0098-4b23-9cd5-dd763fdabf3b,
  abstract     = {Patients with diabetes mellitus have more extensive coronary artery disease, more disease progression, and restenosis. The use of drug-eluting stents (DES) in these patients is widespread, despite uncertain long-term safety and efficacy. All consecutive patients with diabetes mellitus in Sweden who underwent percutaneous coronary intervention were entered into the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) during 2003-06 with complete follow-up for 1-4 years (median 2.5). Patients who received at least one DES (n = 4754) were compared with those who received only bare metal stents (BMS) (n = 4956) at the index procedure. Combined outcome of death or myocardial infarction (MI) showed no difference for DES vs. BMS, relative risk (RR), 0.91 [95% confidence interval (CI), 0.77-1.06]. Myocardial infarction was significantly less common with DES in patients who received only one stent RR, 0.80 (95% CI, 0.66-0.96). The restenosis rate was 50% lower in DES-treated patients RR, 0.50 (95% CI, 0.35-0.70) and was associated with a higher adjusted RR of MI, RR, 5.03 (95% CI, 4.25-5.97). DES was associated with reduced restenosis rates in all subgroups of diabetic patients with the greatest benefit in stent diameters &lt; 3 mm or stent length &gt; 20 mm. The number of lesions treated with DES to prevent one restenosis ranged from 11 to 47 in various subgroups. This real-life registry study shows that restenosis was halved by DES in diabetic patients with stable or unstable coronary disease, with similar risk of death or MI up to 4 years compared with BMS.},
  author       = {Stenestrand, Ulf and James, Stefan K. and Lindback, Johan and Frobert, Ole and Carlsson, Jorg and Scherstén, Fredrik and Nilsson, Tage and Lagerqvist, Bo},
  issn         = {1522-9645},
  keyword      = {Percutaneous coronary intervention,Revascularization,Drug-eluting stent,Mortality,Diabetes mellitus,Outcome,Myocardial infarction},
  language     = {eng},
  number       = {2},
  pages        = {177--186},
  publisher    = {Oxford University Press},
  series       = {European Heart Journal},
  title        = {Safety and efficacy of drug-eluting vs. bare metal stents in patients with diabetes mellitus: long-term follow-up in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)},
  url          = {http://dx.doi.org/10.1093/eurheartj/ehp424},
  volume       = {31},
  year         = {2010},
}