Impact of coronary lesion complexity on drug-eluting stent outcomes in patients with and without diabetes mellitus

Analysis from 18 pooled randomized trials

Elvin Kedhi, Philippe Genereux, Tullio Palmerini, Thomas C. McAndrew, Helen Parise, Roxana Mehran, George D. Dangas, Gregg W. Stone

Research output: Contribution to journalArticle

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Abstract

Objectives The aim of this study was to investigate whether baseline lesion complexity affects drug-eluting stent (DES) outcomes according to diabetic status. Background Previous studies have reported conflicting results regarding DES safety and efficacy in patients with and without diabetes mellitus (DM). Methods Patient-level data from 18 prospective randomized trials were pooled. DES treatment outcomes in patients with versus without DM were analyzed in 2 propensity score-matched groups further stratified according to lesion complexity (American College of Cardiology and American Heart Association class A/B1 vs. B2/C). Remaining baseline differences were adjusted for by multivariate analysis. Results DM was present in 3,467 of 18,441 patients (18.8%). DM was a predictor of 1-year repeat revascularization (target lesion revascularization: hazard ratio: 1.34; 95% confidence interval: 1.05 to 1.70; target vessel revascularization: hazard ratio: 1.40; 95% confidence interval: 1.15 to 1.72) and cardiac death or myocardial infarction (hazard ratio: 1.40; 95% confidence interval: 1.09 to 1.81). Rates of target lesion and target vessel revascularization were significantly higher in patients with versus those without DM with type B2/C lesions (8.0% vs. 4.5% and 10.6% vs. 5.9%, respectively, p < 0.0001 for both), but not in patients with only type A/B1 lesions (4.6% vs. 4.8%, p = 0.87, and 7.4% vs. 6.8%, p = 0.47, respectively), with a significant interaction between DM and lesion type observed for both endpoints (p = 0.01 and p = 0.02, respectively). No interaction was observed for death or myocardial infarction (p = 0.28). Conclusions In the DES era, patients with DM remain at increased risk for cardiac death or myocardial infarction. However, DM is a risk factor for repeat revascularization only in those patients with complex lesions; patients with DM and noncomplex lesions have similar rates of 1-year freedom from repeat revascularization as do patients without DM.

Original languageEnglish (US)
Pages (from-to)2111-2118
Number of pages8
JournalJournal of the American College of Cardiology
Volume63
Issue number20
DOIs
StatePublished - May 27 2014
Externally publishedYes

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Drug-Eluting Stents
Diabetes Mellitus
Myocardial Infarction
Confidence Intervals
Propensity Score
Research Design
Multivariate Analysis
Safety

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kedhi, Elvin ; Genereux, Philippe ; Palmerini, Tullio ; McAndrew, Thomas C. ; Parise, Helen ; Mehran, Roxana ; Dangas, George D. ; Stone, Gregg W. / Impact of coronary lesion complexity on drug-eluting stent outcomes in patients with and without diabetes mellitus : Analysis from 18 pooled randomized trials. In: Journal of the American College of Cardiology. 2014 ; Vol. 63, No. 20. pp. 2111-2118.
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title = "Impact of coronary lesion complexity on drug-eluting stent outcomes in patients with and without diabetes mellitus: Analysis from 18 pooled randomized trials",
abstract = "Objectives The aim of this study was to investigate whether baseline lesion complexity affects drug-eluting stent (DES) outcomes according to diabetic status. Background Previous studies have reported conflicting results regarding DES safety and efficacy in patients with and without diabetes mellitus (DM). Methods Patient-level data from 18 prospective randomized trials were pooled. DES treatment outcomes in patients with versus without DM were analyzed in 2 propensity score-matched groups further stratified according to lesion complexity (American College of Cardiology and American Heart Association class A/B1 vs. B2/C). Remaining baseline differences were adjusted for by multivariate analysis. Results DM was present in 3,467 of 18,441 patients (18.8{\%}). DM was a predictor of 1-year repeat revascularization (target lesion revascularization: hazard ratio: 1.34; 95{\%} confidence interval: 1.05 to 1.70; target vessel revascularization: hazard ratio: 1.40; 95{\%} confidence interval: 1.15 to 1.72) and cardiac death or myocardial infarction (hazard ratio: 1.40; 95{\%} confidence interval: 1.09 to 1.81). Rates of target lesion and target vessel revascularization were significantly higher in patients with versus those without DM with type B2/C lesions (8.0{\%} vs. 4.5{\%} and 10.6{\%} vs. 5.9{\%}, respectively, p < 0.0001 for both), but not in patients with only type A/B1 lesions (4.6{\%} vs. 4.8{\%}, p = 0.87, and 7.4{\%} vs. 6.8{\%}, p = 0.47, respectively), with a significant interaction between DM and lesion type observed for both endpoints (p = 0.01 and p = 0.02, respectively). No interaction was observed for death or myocardial infarction (p = 0.28). Conclusions In the DES era, patients with DM remain at increased risk for cardiac death or myocardial infarction. However, DM is a risk factor for repeat revascularization only in those patients with complex lesions; patients with DM and noncomplex lesions have similar rates of 1-year freedom from repeat revascularization as do patients without DM.",
author = "Elvin Kedhi and Philippe Genereux and Tullio Palmerini and McAndrew, {Thomas C.} and Helen Parise and Roxana Mehran and Dangas, {George D.} and Stone, {Gregg W.}",
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Impact of coronary lesion complexity on drug-eluting stent outcomes in patients with and without diabetes mellitus : Analysis from 18 pooled randomized trials. / Kedhi, Elvin; Genereux, Philippe; Palmerini, Tullio; McAndrew, Thomas C.; Parise, Helen; Mehran, Roxana; Dangas, George D.; Stone, Gregg W.

In: Journal of the American College of Cardiology, Vol. 63, No. 20, 27.05.2014, p. 2111-2118.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of coronary lesion complexity on drug-eluting stent outcomes in patients with and without diabetes mellitus

T2 - Analysis from 18 pooled randomized trials

AU - Kedhi, Elvin

AU - Genereux, Philippe

AU - Palmerini, Tullio

AU - McAndrew, Thomas C.

AU - Parise, Helen

AU - Mehran, Roxana

AU - Dangas, George D.

AU - Stone, Gregg W.

PY - 2014/5/27

Y1 - 2014/5/27

N2 - Objectives The aim of this study was to investigate whether baseline lesion complexity affects drug-eluting stent (DES) outcomes according to diabetic status. Background Previous studies have reported conflicting results regarding DES safety and efficacy in patients with and without diabetes mellitus (DM). Methods Patient-level data from 18 prospective randomized trials were pooled. DES treatment outcomes in patients with versus without DM were analyzed in 2 propensity score-matched groups further stratified according to lesion complexity (American College of Cardiology and American Heart Association class A/B1 vs. B2/C). Remaining baseline differences were adjusted for by multivariate analysis. Results DM was present in 3,467 of 18,441 patients (18.8%). DM was a predictor of 1-year repeat revascularization (target lesion revascularization: hazard ratio: 1.34; 95% confidence interval: 1.05 to 1.70; target vessel revascularization: hazard ratio: 1.40; 95% confidence interval: 1.15 to 1.72) and cardiac death or myocardial infarction (hazard ratio: 1.40; 95% confidence interval: 1.09 to 1.81). Rates of target lesion and target vessel revascularization were significantly higher in patients with versus those without DM with type B2/C lesions (8.0% vs. 4.5% and 10.6% vs. 5.9%, respectively, p < 0.0001 for both), but not in patients with only type A/B1 lesions (4.6% vs. 4.8%, p = 0.87, and 7.4% vs. 6.8%, p = 0.47, respectively), with a significant interaction between DM and lesion type observed for both endpoints (p = 0.01 and p = 0.02, respectively). No interaction was observed for death or myocardial infarction (p = 0.28). Conclusions In the DES era, patients with DM remain at increased risk for cardiac death or myocardial infarction. However, DM is a risk factor for repeat revascularization only in those patients with complex lesions; patients with DM and noncomplex lesions have similar rates of 1-year freedom from repeat revascularization as do patients without DM.

AB - Objectives The aim of this study was to investigate whether baseline lesion complexity affects drug-eluting stent (DES) outcomes according to diabetic status. Background Previous studies have reported conflicting results regarding DES safety and efficacy in patients with and without diabetes mellitus (DM). Methods Patient-level data from 18 prospective randomized trials were pooled. DES treatment outcomes in patients with versus without DM were analyzed in 2 propensity score-matched groups further stratified according to lesion complexity (American College of Cardiology and American Heart Association class A/B1 vs. B2/C). Remaining baseline differences were adjusted for by multivariate analysis. Results DM was present in 3,467 of 18,441 patients (18.8%). DM was a predictor of 1-year repeat revascularization (target lesion revascularization: hazard ratio: 1.34; 95% confidence interval: 1.05 to 1.70; target vessel revascularization: hazard ratio: 1.40; 95% confidence interval: 1.15 to 1.72) and cardiac death or myocardial infarction (hazard ratio: 1.40; 95% confidence interval: 1.09 to 1.81). Rates of target lesion and target vessel revascularization were significantly higher in patients with versus those without DM with type B2/C lesions (8.0% vs. 4.5% and 10.6% vs. 5.9%, respectively, p < 0.0001 for both), but not in patients with only type A/B1 lesions (4.6% vs. 4.8%, p = 0.87, and 7.4% vs. 6.8%, p = 0.47, respectively), with a significant interaction between DM and lesion type observed for both endpoints (p = 0.01 and p = 0.02, respectively). No interaction was observed for death or myocardial infarction (p = 0.28). Conclusions In the DES era, patients with DM remain at increased risk for cardiac death or myocardial infarction. However, DM is a risk factor for repeat revascularization only in those patients with complex lesions; patients with DM and noncomplex lesions have similar rates of 1-year freedom from repeat revascularization as do patients without DM.

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