Long-term outcomes after coronary bare-metal-stent and drug-eluting-stent implantations: a 'real-world' comparison among patients with diabetes with diffuse small vessel coronary artery disease.

BACKGROUND AND AIM: Drug-eluting stents (DESs) have been reported to be more efficacious compared with bare-metal stents (BMSs) in reducing the need for target vessel revascularization (TVR). However, the long-term benefits for patients with diabetes with small vessel disease are less certain. We aim to determine the clinical outcome of patients with diabetes with diffuse small vessel coronary artery disease who undergo percutaneous coronary intervention.

METHODS: This is a single-center prospective registry of all patients with diabetes with target lesions implanted with stents that were 2.25 mm or less in diameter and approximately 20 mm in total stent length between January 2002 and October 2008. Primary outcome was combined major adverse cardiovascular events: death, nonfatal myocardial infarction and TVR up to 5 years. Outcomes were adjusted for age, sex and cardiovascular risk factors.

RESULTS: There were 544 patients (63% males, mean age 62±10 years) with 1010 lesions that were followed up for a mean duration of 3±2 years. Two hundred and thirty-nine patients (439 lesions) received BMS whereas 305 (571 lesions) received DES. DES lesions were longer (mean length 23.3±6.96 vs. 17.8±5.02 mm, P<0.001) than BMS lesions. Procedural success was similar for BMS and DES patients (86.2 vs. 86.6%, P=0.90). DES patients had less TVR at 6 months [3.9 vs. 9.2%, odds ratio (OR): 4.90, 95% confidence interval (CI): 1.53-15.65, P=0.007], 1 year (1 vs. 3.8%, OR: 8.01, 95% CI: 1.25-51.10, P=0.028) and 3 years (13.8 vs. 18.0%, OR: 5.50, 95% CI: 3.74-8.13, P=0.043). By 5 years, the primary outcome was lower in DES patients (21.6 vs. 28%, OR: 1.79, 95% CI: 1.14-2.80, P=0.011). Independent predictors of TVR at 6 months were above or equal to 59 years of age (OR: 0.95, 95% CI: 0.90-1.00, P=0.032) and use of glycoprotein-IIbIIIa inhibitors (OR: 0.02, 95% CI: 0.001-0.50, P=0.018). Stent length was not a significant predictor of TVR.

CONCLUSION: Our observational analysis suggests that DES seems to have short-term and mid-term advantages over BMS in reducing TVR and overall major adverse cardiovascular events. Percutaneous coronary intervention with DES may be considered as an option in these patients with limited revascularization options.