medigraphic.com

2002, Number 1

<< Back Next >>

Arch Cardiol Mex 2002; 72 (1)

Immediate and mid-term results of coronary stent implants in diabetic patients

Palomo VJA, Reyes CF, Montoya SA, Farell CJ, Abundes VA, Ruanova LD, Ledesma M

Language: Spanish
References: 47
Page: 36-44
PDF size: 108.70 Kb.


ABSTRACT

Introduction: We analyzed the clinical and angiographic outcome, including follow-up, in diabetic, patients treated with percutaneous transluminal coronary angioplasty (PTCA) and stenting. Material and methods: Between January 1995 and December 1999, 770 patients were treated with PTCA, 137 of them with diabetes (DM), 17.7% received 160 stents, average 1.16 stent/patient. Mean age was 58.70 ± 8.44 years (range 35 to 80 years) and there were 92 men and 45 women. According to the clinical presentation, there were 54% with severe angina based on criteria from the Canadian Cardiovascular Society (CCS). Sixty two percent of patients had prior myocardial infarction and 68% had multivessel disease. Mean vascular obstruction was 90 ± 6.3% and the ejection fraction was 45.3 ± 8.7%. Results: The immediate angiographic success was 94.4% in patients with DM. There were complications in 8.4% (acute myocardial infarction, and thrombosis). The average follow-up was 10 mouths (range 6 to 36) in 94% of the cases. The mortality was 4.3%. Conclusions: These results show that PTCA and stenting in patients with DM is a successful procedure, with few clinical and angiographics complications.


REFERENCES

  1. Escobedo de la Peña J: Frecuencia de la diabetes mellitus: Mortalidad y Morbilidad. Temas de Medicina Interna: Interamericana. Asociación de Medicina Interna de México; 1993 (1)4: 643-653.

  2. Instituto Nacional de Nutrición Salvador Zubirán: Encuesta nacional de enfermedades crónicas: México. Dirección general de Epidemiología; 1993.

  3. Esmatjes E, Vidal J: Repercusión cardiaca de la diabetes mellitus. Rev Esp Cardiol 1998; 51: 8: 661-670.

  4. Hamby R, Sherman L, Metha J, Aintablian A: Repraisal of the role of diabetic state in coronary artery disease. Chest 1976; 70; 251-257.

  5. Dortimer A, Shenoy P, Shiroff R, Leaman D, Babb J, Liedtke A, et al: Diffuse coronary artery disease in diabetic patients: fact or fiction? Circulation 1978; 57: 133-136.

  6. Kannel W, McGee D: Diabetes and cardiovascular disease: the Framingham Study. JAMA 1979; 241: 2035-2038.

  7. Uusitupa M, Niskanen L, Siitonen O, Voutilainen E, Pyorala K: 5-year incidence of atherosclerotic vascular disease in relation to general risk factor, insulin level, and abnormalities in lipoprotein composition in non-insulin-dependent diabetic and nondiabetic subjects. Circulation 1990; 82: 27-36.

  8. Krolewski A, Kozinski E, Warram J, Leland O, Busick E, Asmal A, et al: Magnitude and determinants of coronary artery disease in juvenile-onset, insulin-dependent diabetes mellitus. Am J Cardiol 1987; 59: 750-755.

  9. Stamler J, Vaccaro O, Neaton JD, Wenworth D, for the Multiple Risk Factor Interventional Trial Research Group: Diabetes, other risk factors and 12 year cardiovascular mortality for men screened in the multiple risk factor interventional trial. Diabetes Care 1993; 16: 434-444.

  10. Barzilay J, Kronmal R, Bittner V, Eaker E, Evans C, Foster E: Coronary artery disease and coronary artery bypass grafting in diabetic patients aged > 65 years: report from the coronary artery surgery study (CASS) registry. Am J Cardiol 1994; 74: 334-339.

  11. Lawrie G, Morris G, Glaeser D: Influence of diabetes mellitus on the results of coronary bypass surgery. JAMA 1986; 21: 2967-2971.

  12. Morris J, Smith L, Jones R, Glower D, Morris P, Muhlbaier L, et al: Influence of diabetes and mammary artery grafting on survival after coronary bypass. Circulation 1991; 84 (Suppl 3): III 275-III 283.

  13. Stein B, Weintraub W, Gebhart S, Cohen C, Grosswald R, Liberman H, et al: Influence of diabetes mellitus on early and late outcome after percutaneous transluminal coronary angioplasty. Circulation 1995; 91: 979-989.

  14. Kip K, Faxon D, Detre K: Coronary angioplasty in diabetic patients: the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. Circulation 1996; 94: 1818-1825.

  15. Savage M, Fischman D, Slota P, Rake R, Leon M, Schatz R: Coronary intervention in the diabetic patient: improved outcome following stent implantation versus balloon angioplasty. J Am Coll Cardiol 1997; 29(Suppl A): 188 A.

  16. Van B, Bauters C, Hubert R, Bodart J, Abolmaali K, Meurice T: Reestenosis rates in diabetic patients: a comparison of coronary stenting and balloon angioplasty in native coronary arteries. Circulation 1997; 96: 1454-1460.

  17. Califf R, Fortin D, Frid D, Harlan W, Ohman M, Bengtson J: Restenosis after coronary angioplasty: an overview. J Am Coll Cardiol 1991; 17: 2B-13B.

  18. The Bypass Augioplasty Revascularization Investigation (BARI) Investigators: Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease: N Engl J Med 1996; 335: 217-225.

  19. Carroza J, Kuntz R, Fishman R, Baim D: Reestenosis after arterial injury caused by coronary stenting in patients with diabetes mellitus. Ann Intern Med 1993; 118: 344-349.

  20. Fischman D, Leon M, Baim D: A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 1994; 335: 496-501.

  21. Serruys P, de Jaeger P, Kiemenei F: A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med 1994; 331: 489-495.

  22. Elezi S, Schulen H, Wehinger A, Zitzmann-Roth E, Walter H, Hausleiter J: Stent placement in diabetic versus non-diabetic patients. Six-month angiographic follow-up. J Am Coll Cardiol 1997; 29: (Suppl A): 188.

  23. Yokoi H, Nosaka H, Kimura T, Tamura T, Nakagawa Y, Hamasaki N, et al: Coronary stenting in the diabetic patients: early and follow-up results. J Am Coll Cardiol 1997; 29: (Suppl A): 455 A.

  24. Abizaid A, Mehran R, Bucher T, Greenberg A, Poma J, Mintz G, et al: Does diabetes influence clinical recurrence after coronary stent implantation. J Am Coll Cardiol 1997; 29: (Suppl A): 188 A.

  25. Elezi S, Kastrati A, Pache J, Wehinger A, Hadamitzky M, Dirschinger J, et al: Diabetes mellitus and the clinical and angiographic outcome after coronary stent placement. J Am Coll Cardiol 1998; 32: 1866-1873.

  26. Ledesma M, Farell J, Astudillo R, Abundes A, Escudero J, Montoya S, et al: Stents coronarios: Experiencia en el Hospital de Cardiología del Centro Médico Nacional Siglo XXI. Arch Inst Cardiol Mex 1997; 67: 101-105.

  27. Villavicencio R, Marchena A, Eid G, Lechuga A, Peña M, Gaspar J, et al: Stent coronario en el infarto agudo del miocardio. Arch Inst Cardiol Mex 1998; 68: 18-26.

  28. Palomo J, Solorio S, Farell J, Abundes A, Ledesma A: Resultados inmediatos post implante de stents coronarios en pacientes octogenarios. Arch Inst Cardiol Mex 1999; 69: 445- 453.

  29. Mock M, Holmes D, Vliestra R, Gersh B, Detret K, Kelsey N, et al: Percutaneous transluminal coronary angioplasty (PTCA) in the elderly patients: experience in the National Heart, Lung and Blood Institute PTCA Registry. Am J Cardiol 1984; 53: 89C-91C.

  30. Grundy S, Balady G, Criqui M, Fletcher G, Greenland P: Primary prevention of coronary heart disease: Guidance from Framingham. A statement for health care professionals from the AHA Task Forse on Risk Reduction. Circulation 1998; 97: 1876-1887.

  31. Berger P, Bell M, Grill D, Melby S, Holmes D: Frequency of adverse clinical events in the 12 following successfull intracoronary stent placement in patients treated with aspirin and ticlopidine. Am J Cardiol 1999; 81: 713-718.

  32. Moussa I, Oetgen M, Roubin G, Colombo A, Wang X: Effectiveness of clopidogrel and aspirin versus ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation. Circulation 1999; 18: 2364-2366.

  33. Kleinman N, Lincoff A, Kereiakes D, Millier D, Aguirre F: Diabetes mellitus, glycoprotein IIb/IIIa blockade, and heparin. Evidence for a complex interaction in metacenters trial. Circulation 1998; 97: 1912-1920.

  34. Quigley P, Hlatky M, Hinohara T, Rendal D, Perez J: Repeat percutaneous transluminal coronary angioplasty and predictors of recurrent reestenosis. Am J Cardiol 1989; 63: 409-413.

  35. Abizaid A, Kornoski R, Mintz G, Hong M: The influence of diabetes mellitus on acute and late clinical outcomes following coronary stent implantation. J Am Coll Cardiol 1998; 32: 584-589.

  36. Belle E, Bauters C, Huberts E, Bodadrt J, Abolmaali K: Reestenosis rates in diabetic patients. A comparison of coronary stenting and ballon angioplasty in native coronary vessels. Circulation 1997; 96: 1454-1460.

  37. Elezi S, Kastrati A, Pache J, Wehinger A, Hadamitzy M: Diabetes mellitus and the clinical and angiographic outcome after coronary stent placement. J Am Coll Cardiol 1998; 32: 1866-1873.

  38. Ellis C, Vandormael M, Cwley M, Disciascio G, Deligonul U: Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Circulation 1990; 82: 1192-1202.

  39. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators: Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med 1996; 335: 229-234.

  40. BARI Investigators: Influence of diabetes on 5 year mortality in a randomized trial comparing CABG and PTCA in patient with multivessel disease: The Bypass Angioplasty Revascularization (BARI). Circulation 1997; 96: 1761-1769.

  41. Kip K, Faxon D, Detre K, Yeh W, Kelsey S: Coronary angioplasty in patients diabetics. The National, Heart, Lung and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. Circulation 1996; 94: 1818-1825.

  42. O’keffe J, Blokcstone E, Sergeant P, McCallister B: The optimal mode of coronary revascularization for diabetic. A risck adjusted long-term study comparing coronary angioplasty and coronary bypass surgery. Eur Heart J 1998; 19: 1696-1703.

  43. Weintroub W, Stein B, Kosinky A, Douglas J, Gazzal Z: Outcome of coronary bypass surgery vs coronary angioplasty in diabetic patients with multivessel coronary artery disease. J Am Coll Cardiol 1998; 31: 10-19.

  44. O’neill W: Multivessel balloon angioplasty shud be abandoned in diabetic patient. J Am Coll Cardiol 1998; 31: 20-22.

  45. Gum P, O’keffe, Borkon A, Spertus J, Bateman T: Bypass surgery vs coronary angioplasty for revascularization of treated diabetics patients. Circulation 1997; 96: (Suppl II): 7-10.

  46. Weintroub W, King III S, Guyton R, Kosinky A: Coronary surgery and PTCA in diabetics with multivessel disease: Can of BARI results be generalized. Circulation 1996; 94 (Suppl I): 435.

  47. Barseness G, Peterson E, Ohman E, Nelson Ch, Delong E: Relationship between diabetes mellitus and long-term survival after coronary bypass and angioplasty. Circulation 1997; 96: 2551-2556.




2020     |     www.medigraphic.com