Drug-Eluting or Bare-Metal Stenting in Patients With Diabetes Mellitus : Results From the Massachusetts Data Analysis Center Registry
Patients with diabetes mellitus (DM) are at high risk for restenosis, myocardial infarction, and cardiac mortality after coronary stenting, and the long-term safety of drug-eluting stents (DES) relative to bare-metal stents (BMS) in DM is uncertain. We report on a large consecutive series of patient...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2008-11, Vol.118 (22), p.2277-2285 |
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| creator | GARG, Pallav NORMAND, Sharon-Lise T SILBAUGH, Treacy S WOLF, Robert E ZELEVINSKY, Katya LOVETT, Ann VARMA, Manu R ZHENG ZHOU MAURI, Laura |
| description | Patients with diabetes mellitus (DM) are at high risk for restenosis, myocardial infarction, and cardiac mortality after coronary stenting, and the long-term safety of drug-eluting stents (DES) relative to bare-metal stents (BMS) in DM is uncertain. We report on a large consecutive series of patients with DM followed up for 3 years after DES and BMS from a regional contemporary US practice with mandatory reporting.
All adults with DM undergoing percutaneous coronary intervention with stenting between April 1, 2003, and September 30, 2004, at all acute care nonfederal hospitals in Massachusetts were identified from a mandatory state database. According to index admission stent type, patients were classified as DES treated if all stents were drug eluting and as BMS treated if all stents were bare metal; patients treated with both types of stents were excluded from the primary analysis. Mortality rates were obtained from vital statistics records, and myocardial infarction and revascularization rates were obtained from the state database with complete 3 years of follow-up on the entire cohort. Risk-adjusted mortality, myocardial infarction, and revascularization differences (DES-BMS) were estimated with propensity-score matching based on clinical, procedural, hospital, and insurance information collected at the index admission. DM was present in 5051 patients (29% of the population) treated with DES or BMS during the study. Patients with DM were more likely to receive DES than BMS (66.1% versus 33.9%; P |
| doi_str_mv | 10.1161/CIRCULATIONAHA.108.820159 |
| format | Article |
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All adults with DM undergoing percutaneous coronary intervention with stenting between April 1, 2003, and September 30, 2004, at all acute care nonfederal hospitals in Massachusetts were identified from a mandatory state database. According to index admission stent type, patients were classified as DES treated if all stents were drug eluting and as BMS treated if all stents were bare metal; patients treated with both types of stents were excluded from the primary analysis. Mortality rates were obtained from vital statistics records, and myocardial infarction and revascularization rates were obtained from the state database with complete 3 years of follow-up on the entire cohort. Risk-adjusted mortality, myocardial infarction, and revascularization differences (DES-BMS) were estimated with propensity-score matching based on clinical, procedural, hospital, and insurance information collected at the index admission. DM was present in 5051 patients (29% of the population) treated with DES or BMS during the study. Patients with DM were more likely to receive DES than BMS (66.1% versus 33.9%; P<0.001). The unadjusted cumulative incidence of mortality at 3 years was 14.4% in DES versus 22.2% in BMS (P<0.001). Based on propensity-score analysis of 1:1 matched DES versus BMS patients (1476 DES:1476 BMS), the risk-adjusted mortality, MI, and target vessel revascularization rates at 3 years were 17.5% versus 20.7% (risk difference, -3.2%; 95% confidence interval, -6.0 to -0.4; P=0.02), 13.8% versus 16.9% (-3.0%; 95% confidence interval, -5.6 to 0.5; P=0.02), and 18.4% versus 23.7% (-5.4%; confidence interval, -8.3 to -2.4; P<0.001), respectively.
In a real-world diabetic patient population with mandatory reporting and follow-up, DES were associated with reduced mortality, myocardial infarction, and revascularization rates at long-term follow-up compared with BMS.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.108.820159</identifier><identifier>PMID: 19001019</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adolescent ; Adult ; Aged ; Associated diseases and complications ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Cause of Death ; Cohort Studies ; Coronary Disease - mortality ; Coronary Disease - surgery ; Databases, Factual - standards ; Diabetes Complications - mortality ; Diabetes Complications - surgery ; Diabetes Mellitus - drug therapy ; Diabetes. Impaired glucose tolerance ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Drug-Eluting Stents ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Equipment Design ; Female ; Follow-Up Studies ; Humans ; Male ; Massachusetts ; Medical sciences ; Metals ; Middle Aged ; Myocardial Infarction - epidemiology ; Myocardial Infarction - mortality ; Myocardial Ischemia - complications ; Myocardial Ischemia - mortality ; Myocardial Ischemia - surgery ; Safety ; Young Adult</subject><ispartof>Circulation (New York, N.Y.), 2008-11, Vol.118 (22), p.2277-2285</ispartof><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c332t-dab38656f394fbb30a73e5a8ad8408c181496fd558c585a20a608d7472a5e6d13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20904944$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19001019$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>GARG, Pallav</creatorcontrib><creatorcontrib>NORMAND, Sharon-Lise T</creatorcontrib><creatorcontrib>SILBAUGH, Treacy S</creatorcontrib><creatorcontrib>WOLF, Robert E</creatorcontrib><creatorcontrib>ZELEVINSKY, Katya</creatorcontrib><creatorcontrib>LOVETT, Ann</creatorcontrib><creatorcontrib>VARMA, Manu R</creatorcontrib><creatorcontrib>ZHENG ZHOU</creatorcontrib><creatorcontrib>MAURI, Laura</creatorcontrib><title>Drug-Eluting or Bare-Metal Stenting in Patients With Diabetes Mellitus : Results From the Massachusetts Data Analysis Center Registry</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Patients with diabetes mellitus (DM) are at high risk for restenosis, myocardial infarction, and cardiac mortality after coronary stenting, and the long-term safety of drug-eluting stents (DES) relative to bare-metal stents (BMS) in DM is uncertain. We report on a large consecutive series of patients with DM followed up for 3 years after DES and BMS from a regional contemporary US practice with mandatory reporting.
All adults with DM undergoing percutaneous coronary intervention with stenting between April 1, 2003, and September 30, 2004, at all acute care nonfederal hospitals in Massachusetts were identified from a mandatory state database. According to index admission stent type, patients were classified as DES treated if all stents were drug eluting and as BMS treated if all stents were bare metal; patients treated with both types of stents were excluded from the primary analysis. Mortality rates were obtained from vital statistics records, and myocardial infarction and revascularization rates were obtained from the state database with complete 3 years of follow-up on the entire cohort. Risk-adjusted mortality, myocardial infarction, and revascularization differences (DES-BMS) were estimated with propensity-score matching based on clinical, procedural, hospital, and insurance information collected at the index admission. DM was present in 5051 patients (29% of the population) treated with DES or BMS during the study. Patients with DM were more likely to receive DES than BMS (66.1% versus 33.9%; P<0.001). The unadjusted cumulative incidence of mortality at 3 years was 14.4% in DES versus 22.2% in BMS (P<0.001). Based on propensity-score analysis of 1:1 matched DES versus BMS patients (1476 DES:1476 BMS), the risk-adjusted mortality, MI, and target vessel revascularization rates at 3 years were 17.5% versus 20.7% (risk difference, -3.2%; 95% confidence interval, -6.0 to -0.4; P=0.02), 13.8% versus 16.9% (-3.0%; 95% confidence interval, -5.6 to 0.5; P=0.02), and 18.4% versus 23.7% (-5.4%; confidence interval, -8.3 to -2.4; P<0.001), respectively.
In a real-world diabetic patient population with mandatory reporting and follow-up, DES were associated with reduced mortality, myocardial infarction, and revascularization rates at long-term follow-up compared with BMS.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Associated diseases and complications</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Cause of Death</subject><subject>Cohort Studies</subject><subject>Coronary Disease - mortality</subject><subject>Coronary Disease - surgery</subject><subject>Databases, Factual - standards</subject><subject>Diabetes Complications - mortality</subject><subject>Diabetes Complications - surgery</subject><subject>Diabetes Mellitus - drug therapy</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Drug-Eluting Stents</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Equipment Design</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Massachusetts</subject><subject>Medical sciences</subject><subject>Metals</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Ischemia - complications</subject><subject>Myocardial Ischemia - mortality</subject><subject>Myocardial Ischemia - surgery</subject><subject>Safety</subject><subject>Young Adult</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkc-O0zAQxi0EYsvCKyBzgFuKHf-JzS2ku2yllkXLrjhGk8RpjdJk8TiHPgDvjaEViNNoPv2-Gc18hLzhbMm55u-r9V31sCnv17efy5tyyZlZmpxxZZ-QBVe5zKQS9ilZMMZsVog8vyAvEL-nVotCPScX3DLGGbcL8nMV5l12NczRjzs6BfoRgsu2LsJAv0Y3_pH9SL9A9KlD-s3HPV15aFx0SLduGHyckX6gdw7nIQHXYTrQuHd0C4jQ7md0MckriEDLEYYjeqRVmuVC8uw8xnB8SZ71MKB7da6X5OH66r66yTa3n9ZVuclaIfKYddAIo5XuhZV90wgGhXAKDHRGMtNyw6XVfaeUaZVRkDPQzHSFLHJQTndcXJJ3p7mPYfoxO4z1wWObboDRTTPW2houhNYJtCewDRNicH39GPwBwrHmrP6dQf1_Bkk29SmD5H19XjI3B9f9c56fnoC3ZwCwhaEPMLYe_3I5s0xaKcUvUgaR7Q</recordid><startdate>20081125</startdate><enddate>20081125</enddate><creator>GARG, Pallav</creator><creator>NORMAND, Sharon-Lise T</creator><creator>SILBAUGH, Treacy S</creator><creator>WOLF, Robert E</creator><creator>ZELEVINSKY, Katya</creator><creator>LOVETT, Ann</creator><creator>VARMA, Manu R</creator><creator>ZHENG ZHOU</creator><creator>MAURI, Laura</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20081125</creationdate><title>Drug-Eluting or Bare-Metal Stenting in Patients With Diabetes Mellitus : Results From the Massachusetts Data Analysis Center Registry</title><author>GARG, Pallav ; NORMAND, Sharon-Lise T ; SILBAUGH, Treacy S ; WOLF, Robert E ; ZELEVINSKY, Katya ; LOVETT, Ann ; VARMA, Manu R ; ZHENG ZHOU ; MAURI, Laura</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c332t-dab38656f394fbb30a73e5a8ad8408c181496fd558c585a20a608d7472a5e6d13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Associated diseases and complications</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Cause of Death</topic><topic>Cohort Studies</topic><topic>Coronary Disease - mortality</topic><topic>Coronary Disease - surgery</topic><topic>Databases, Factual - standards</topic><topic>Diabetes Complications - mortality</topic><topic>Diabetes Complications - surgery</topic><topic>Diabetes Mellitus - drug therapy</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Drug-Eluting Stents</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Equipment Design</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Massachusetts</topic><topic>Medical sciences</topic><topic>Metals</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Ischemia - complications</topic><topic>Myocardial Ischemia - mortality</topic><topic>Myocardial Ischemia - surgery</topic><topic>Safety</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>GARG, Pallav</creatorcontrib><creatorcontrib>NORMAND, Sharon-Lise T</creatorcontrib><creatorcontrib>SILBAUGH, Treacy S</creatorcontrib><creatorcontrib>WOLF, Robert E</creatorcontrib><creatorcontrib>ZELEVINSKY, Katya</creatorcontrib><creatorcontrib>LOVETT, Ann</creatorcontrib><creatorcontrib>VARMA, Manu R</creatorcontrib><creatorcontrib>ZHENG ZHOU</creatorcontrib><creatorcontrib>MAURI, Laura</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>GARG, Pallav</au><au>NORMAND, Sharon-Lise T</au><au>SILBAUGH, Treacy S</au><au>WOLF, Robert E</au><au>ZELEVINSKY, Katya</au><au>LOVETT, Ann</au><au>VARMA, Manu R</au><au>ZHENG ZHOU</au><au>MAURI, Laura</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Drug-Eluting or Bare-Metal Stenting in Patients With Diabetes Mellitus : Results From the Massachusetts Data Analysis Center Registry</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2008-11-25</date><risdate>2008</risdate><volume>118</volume><issue>22</issue><spage>2277</spage><epage>2285</epage><pages>2277-2285</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Patients with diabetes mellitus (DM) are at high risk for restenosis, myocardial infarction, and cardiac mortality after coronary stenting, and the long-term safety of drug-eluting stents (DES) relative to bare-metal stents (BMS) in DM is uncertain. We report on a large consecutive series of patients with DM followed up for 3 years after DES and BMS from a regional contemporary US practice with mandatory reporting.
All adults with DM undergoing percutaneous coronary intervention with stenting between April 1, 2003, and September 30, 2004, at all acute care nonfederal hospitals in Massachusetts were identified from a mandatory state database. According to index admission stent type, patients were classified as DES treated if all stents were drug eluting and as BMS treated if all stents were bare metal; patients treated with both types of stents were excluded from the primary analysis. Mortality rates were obtained from vital statistics records, and myocardial infarction and revascularization rates were obtained from the state database with complete 3 years of follow-up on the entire cohort. Risk-adjusted mortality, myocardial infarction, and revascularization differences (DES-BMS) were estimated with propensity-score matching based on clinical, procedural, hospital, and insurance information collected at the index admission. DM was present in 5051 patients (29% of the population) treated with DES or BMS during the study. Patients with DM were more likely to receive DES than BMS (66.1% versus 33.9%; P<0.001). The unadjusted cumulative incidence of mortality at 3 years was 14.4% in DES versus 22.2% in BMS (P<0.001). Based on propensity-score analysis of 1:1 matched DES versus BMS patients (1476 DES:1476 BMS), the risk-adjusted mortality, MI, and target vessel revascularization rates at 3 years were 17.5% versus 20.7% (risk difference, -3.2%; 95% confidence interval, -6.0 to -0.4; P=0.02), 13.8% versus 16.9% (-3.0%; 95% confidence interval, -5.6 to 0.5; P=0.02), and 18.4% versus 23.7% (-5.4%; confidence interval, -8.3 to -2.4; P<0.001), respectively.
In a real-world diabetic patient population with mandatory reporting and follow-up, DES were associated with reduced mortality, myocardial infarction, and revascularization rates at long-term follow-up compared with BMS.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>19001019</pmid><doi>10.1161/CIRCULATIONAHA.108.820159</doi><tpages>9</tpages></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Adolescent Adult Aged Associated diseases and complications Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Cause of Death Cohort Studies Coronary Disease - mortality Coronary Disease - surgery Databases, Factual - standards Diabetes Complications - mortality Diabetes Complications - surgery Diabetes Mellitus - drug therapy Diabetes. Impaired glucose tolerance Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Drug-Eluting Stents Endocrine pancreas. Apud cells (diseases) Endocrinopathies Equipment Design Female Follow-Up Studies Humans Male Massachusetts Medical sciences Metals Middle Aged Myocardial Infarction - epidemiology Myocardial Infarction - mortality Myocardial Ischemia - complications Myocardial Ischemia - mortality Myocardial Ischemia - surgery Safety Young Adult |
| title | Drug-Eluting or Bare-Metal Stenting in Patients With Diabetes Mellitus : Results From the Massachusetts Data Analysis Center Registry |
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