Percutaneous coronary revascularization in diabetics

Objective: Diabetics with coronary artery disease face a high risk of adverse events following coronary revascularization. However, recurrence rates of after the first revascularization have never been appraised. The aim of this study was to evaluate recurrent events in diabetics undergoing percutaneous coronary intervention (PCI) in the current era. Material and Method: Authors collected baseline and outcome data of consecutive type-2 diabetics treated with PCI (January 2005-December 2008). End-points of interest were the long-term rates of major adverse cardiac events (MACE: cardiac death, myocardial infarction [MI], percutaneous target vessel revascularization [TVR-PCI], or coronary artery bypass grafting [CABG]), non-TVR PCI, and stent thrombosis. Results: A total of 429 diabetics were included, 191 (44%) insulin-dependent, with drug-eluting stents implanted in 232 (54%). After a median of 38 months, events were as follows: MACE in 167 (38.9%) subjects, cardiac death in 38 (8.8%), MI in 42(9.8%), TVR PCI in 130 (30.3%), CABG in 11 (6.2%), non-TVR PCI in 52 (12.1%), and definite stent thrombosis (2.1%). Among the 129 patients undergoing TVR PCI as first event, as many as 28 (21.7%) underwent a second TVR PCI, 7 (5.4%) underwent a third TVR PCI, and a further 2 (1.5%) underwent a fourth TVR PCI, whereas CABG was performed in 2 (1.5%)and non-TVR PCI in 4 (3.1%). Conclusion: This work, originally reporting on risk of recurrent repeat revascularization events among diabetics treated with PCI, showed that adverse events occur frequently in these patients, but can be managed in most cases safely and successfully by means of repeat PCI only.