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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