Prognostic Influence of Diabetes Mellitus on Long-Term Clinical Outcomes and Stent Thrombosis After Drug-Eluting Stent Implantation in Asian Patients

Duk Woo Park, James D. Flaherty, Charles J. Davidson, Sung Cheol Yun, Seung Whan Lee, Young Hak Kim, Cheol Whan Lee, Myeong Ki Hong, Sang Sig Cheong, Jae Joong Kim, Seong Wook Park, Seung Jung Park

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Abstract

Diabetes mellitus has been associated with an increased risk of mortality and stent thrombosis after implantation of drug-eluting stents (DES). Little is known about the prognostic impact of diabetes on clinical outcomes in an Asian population treated with DES. We compared adverse outcomes between 865 patients with diabetes and 2,295 patients without diabetes treated with DES after adjustment for differences in baseline risk factors in the patients. The primary outcome was the composite of death, nonfatal myocardial infarction, or target-vessel revascularization (TVR). The 3-year unadjusted rates of death (5.8% vs 3.5%, p = 0.002) and TVR (12.2% vs 8.6%, p = 0.003) were significantly higher in patients with diabetes. After adjustment for baseline differences, the risk of TVR remained higher in patients with diabetes (hazard ratio 1.37, 95% confidence interval [CI] 1.04 to 1.81, p = 0.03), but the risk of death did not (hazard ratio 1.35, 95% CI 0.89 to 2.05, p = 0.16). The 3-year adjusted risk of the primary composite outcome was significantly higher in patients with diabetes compared with patients without diabetes (23.3% vs 16.1%, hazard ratio 1.24, 95% CI 1.02 to 1.51, p = 0.03). Insulin use was an independent predictor for each outcome (death, TVR, and composite outcome). After adjustment by baseline risk profile and for propensity, diabetes was not associated with an increased risk of stent thrombosis (multivariable-adjusted hazard ratio 0.87, 95% CI 0.36 to 2.15, p = 0.77 and propensity-adjusted hazard ratio 0.87, 95% CI 0.37 to 2.06, p = 0.76). In conclusion, diabetic status was associated with increased TVR without a significantly increased rate of death. A diabetes-associated excess risk of stent thrombosis was not observed in Asian patients.

Original languageEnglish
Pages (from-to)646-652
Number of pages7
JournalAmerican Journal of Cardiology
Volume103
Issue number5
DOIs
Publication statusPublished - 2009 Mar 1

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Drug-Eluting Stents
Stents
Diabetes Mellitus
Thrombosis
Confidence Intervals
Mortality
Risk Adjustment
Type 2 Diabetes Mellitus
Myocardial Infarction
Insulin

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Park, Duk Woo ; Flaherty, James D. ; Davidson, Charles J. ; Yun, Sung Cheol ; Lee, Seung Whan ; Kim, Young Hak ; Lee, Cheol Whan ; Hong, Myeong Ki ; Cheong, Sang Sig ; Kim, Jae Joong ; Park, Seong Wook ; Park, Seung Jung. / Prognostic Influence of Diabetes Mellitus on Long-Term Clinical Outcomes and Stent Thrombosis After Drug-Eluting Stent Implantation in Asian Patients. In: American Journal of Cardiology. 2009 ; Vol. 103, No. 5. pp. 646-652.
@article{b599102dd02e497c9ce3ca5f9eb52a69,
title = "Prognostic Influence of Diabetes Mellitus on Long-Term Clinical Outcomes and Stent Thrombosis After Drug-Eluting Stent Implantation in Asian Patients",
abstract = "Diabetes mellitus has been associated with an increased risk of mortality and stent thrombosis after implantation of drug-eluting stents (DES). Little is known about the prognostic impact of diabetes on clinical outcomes in an Asian population treated with DES. We compared adverse outcomes between 865 patients with diabetes and 2,295 patients without diabetes treated with DES after adjustment for differences in baseline risk factors in the patients. The primary outcome was the composite of death, nonfatal myocardial infarction, or target-vessel revascularization (TVR). The 3-year unadjusted rates of death (5.8{\%} vs 3.5{\%}, p = 0.002) and TVR (12.2{\%} vs 8.6{\%}, p = 0.003) were significantly higher in patients with diabetes. After adjustment for baseline differences, the risk of TVR remained higher in patients with diabetes (hazard ratio 1.37, 95{\%} confidence interval [CI] 1.04 to 1.81, p = 0.03), but the risk of death did not (hazard ratio 1.35, 95{\%} CI 0.89 to 2.05, p = 0.16). The 3-year adjusted risk of the primary composite outcome was significantly higher in patients with diabetes compared with patients without diabetes (23.3{\%} vs 16.1{\%}, hazard ratio 1.24, 95{\%} CI 1.02 to 1.51, p = 0.03). Insulin use was an independent predictor for each outcome (death, TVR, and composite outcome). After adjustment by baseline risk profile and for propensity, diabetes was not associated with an increased risk of stent thrombosis (multivariable-adjusted hazard ratio 0.87, 95{\%} CI 0.36 to 2.15, p = 0.77 and propensity-adjusted hazard ratio 0.87, 95{\%} CI 0.37 to 2.06, p = 0.76). In conclusion, diabetic status was associated with increased TVR without a significantly increased rate of death. A diabetes-associated excess risk of stent thrombosis was not observed in Asian patients.",
author = "Park, {Duk Woo} and Flaherty, {James D.} and Davidson, {Charles J.} and Yun, {Sung Cheol} and Lee, {Seung Whan} and Kim, {Young Hak} and Lee, {Cheol Whan} and Hong, {Myeong Ki} and Cheong, {Sang Sig} and Kim, {Jae Joong} and Park, {Seong Wook} and Park, {Seung Jung}",
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Park, DW, Flaherty, JD, Davidson, CJ, Yun, SC, Lee, SW, Kim, YH, Lee, CW, Hong, MK, Cheong, SS, Kim, JJ, Park, SW & Park, SJ 2009, 'Prognostic Influence of Diabetes Mellitus on Long-Term Clinical Outcomes and Stent Thrombosis After Drug-Eluting Stent Implantation in Asian Patients', American Journal of Cardiology, vol. 103, no. 5, pp. 646-652. https://doi.org/10.1016/j.amjcard.2008.11.012

Prognostic Influence of Diabetes Mellitus on Long-Term Clinical Outcomes and Stent Thrombosis After Drug-Eluting Stent Implantation in Asian Patients. / Park, Duk Woo; Flaherty, James D.; Davidson, Charles J.; Yun, Sung Cheol; Lee, Seung Whan; Kim, Young Hak; Lee, Cheol Whan; Hong, Myeong Ki; Cheong, Sang Sig; Kim, Jae Joong; Park, Seong Wook; Park, Seung Jung.

In: American Journal of Cardiology, Vol. 103, No. 5, 01.03.2009, p. 646-652.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prognostic Influence of Diabetes Mellitus on Long-Term Clinical Outcomes and Stent Thrombosis After Drug-Eluting Stent Implantation in Asian Patients

AU - Park, Duk Woo

AU - Flaherty, James D.

AU - Davidson, Charles J.

AU - Yun, Sung Cheol

AU - Lee, Seung Whan

AU - Kim, Young Hak

AU - Lee, Cheol Whan

AU - Hong, Myeong Ki

AU - Cheong, Sang Sig

AU - Kim, Jae Joong

AU - Park, Seong Wook

AU - Park, Seung Jung

PY - 2009/3/1

Y1 - 2009/3/1

N2 - Diabetes mellitus has been associated with an increased risk of mortality and stent thrombosis after implantation of drug-eluting stents (DES). Little is known about the prognostic impact of diabetes on clinical outcomes in an Asian population treated with DES. We compared adverse outcomes between 865 patients with diabetes and 2,295 patients without diabetes treated with DES after adjustment for differences in baseline risk factors in the patients. The primary outcome was the composite of death, nonfatal myocardial infarction, or target-vessel revascularization (TVR). The 3-year unadjusted rates of death (5.8% vs 3.5%, p = 0.002) and TVR (12.2% vs 8.6%, p = 0.003) were significantly higher in patients with diabetes. After adjustment for baseline differences, the risk of TVR remained higher in patients with diabetes (hazard ratio 1.37, 95% confidence interval [CI] 1.04 to 1.81, p = 0.03), but the risk of death did not (hazard ratio 1.35, 95% CI 0.89 to 2.05, p = 0.16). The 3-year adjusted risk of the primary composite outcome was significantly higher in patients with diabetes compared with patients without diabetes (23.3% vs 16.1%, hazard ratio 1.24, 95% CI 1.02 to 1.51, p = 0.03). Insulin use was an independent predictor for each outcome (death, TVR, and composite outcome). After adjustment by baseline risk profile and for propensity, diabetes was not associated with an increased risk of stent thrombosis (multivariable-adjusted hazard ratio 0.87, 95% CI 0.36 to 2.15, p = 0.77 and propensity-adjusted hazard ratio 0.87, 95% CI 0.37 to 2.06, p = 0.76). In conclusion, diabetic status was associated with increased TVR without a significantly increased rate of death. A diabetes-associated excess risk of stent thrombosis was not observed in Asian patients.

AB - Diabetes mellitus has been associated with an increased risk of mortality and stent thrombosis after implantation of drug-eluting stents (DES). Little is known about the prognostic impact of diabetes on clinical outcomes in an Asian population treated with DES. We compared adverse outcomes between 865 patients with diabetes and 2,295 patients without diabetes treated with DES after adjustment for differences in baseline risk factors in the patients. The primary outcome was the composite of death, nonfatal myocardial infarction, or target-vessel revascularization (TVR). The 3-year unadjusted rates of death (5.8% vs 3.5%, p = 0.002) and TVR (12.2% vs 8.6%, p = 0.003) were significantly higher in patients with diabetes. After adjustment for baseline differences, the risk of TVR remained higher in patients with diabetes (hazard ratio 1.37, 95% confidence interval [CI] 1.04 to 1.81, p = 0.03), but the risk of death did not (hazard ratio 1.35, 95% CI 0.89 to 2.05, p = 0.16). The 3-year adjusted risk of the primary composite outcome was significantly higher in patients with diabetes compared with patients without diabetes (23.3% vs 16.1%, hazard ratio 1.24, 95% CI 1.02 to 1.51, p = 0.03). Insulin use was an independent predictor for each outcome (death, TVR, and composite outcome). After adjustment by baseline risk profile and for propensity, diabetes was not associated with an increased risk of stent thrombosis (multivariable-adjusted hazard ratio 0.87, 95% CI 0.36 to 2.15, p = 0.77 and propensity-adjusted hazard ratio 0.87, 95% CI 0.37 to 2.06, p = 0.76). In conclusion, diabetic status was associated with increased TVR without a significantly increased rate of death. A diabetes-associated excess risk of stent thrombosis was not observed in Asian patients.

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