PURPOSE: Diabetes mellitus is a strong risk factor for major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI). It is generally believed that deployment of multiple stents in these diabetic patients might be associated with higher incidence of complications. There is little data on peri-procedural myocardial infarction (MI) and MACE in these high-risk patients receiving multiple stents versus single stent.
METHODS: We studied 229 diabetic patients who underwent PCI focusing on the incidence of MI and MACE, defined as a three fold elevation in serum creatinine phosphokinase (CPK) or CPK-MB levels and a combination of MI, revascularization and deaths from cardiovascular cause respectively.
RESULTS: 75 patients (32.7%) had two or more stents deployed and the remaining had a single stent placed in a single epicardial coronary artery during the index PCI. 22 patients (9.6%) had MI. Over a mean follow-up period of 22 months, 84 patients (36.7%) had MACE. On logistic regression analysis, in patients with multiple stents deployment, there was no significant difference in the incidence of MI (OR 1.114, CI 0.38-3.24, p=0.84) or MACE (OR 1.00, CI 0.52-1.92, p=0.99) when compared to patients with single stent deployment. Presence of renal insufficiency was associated with increased incidence of MACE in both the groups (OR 3.38, CI 1.22-9.33, p=0.019 and OR 8.63, CI 1.07-69.93, p=0.044 in single stent and multiple stent groups respectively). Low levels of serum HDL cholesterol were associated with increased incidence of MACE in the single stent group (HDL: OR 1.43, CI 1.05-1.95, p=0.025). This model was adjusted for target vessel size, complexity of the lesion, type of stent, low density lipoprotein-cholesterol levels and use of GpIIb/IIIa inhibitors following the PCI.
CONCLUSION: In diabetic patients, there is no significant association between the number of stents deployed during PCI and the incidence of peri-procedure MI and MACE.
CLINICAL IMPLICATIONS: The number of stents deployed during PCI in diabetic patients does not influence the incidence of peri-procedure MI or adverse cardiac events.
DISCLOSURE: Ravi Sureddi, No Financial Disclosure Information; No Product/Research Disclosure Information