Evolução tardia após intervenção coronária percutânea com stents farmacológicos em pacientes diabéticos do Registro DESIRE (Drug-Eluting Stents In the REal world)

background: Diabetics, especially insulin-treated diabetics, have more extensive coronary atherosclerosis and impaired vascular remodeling. Our objective was to evaluate in-hospital results of contemporaneous percutaneous coronary intervention (PCI) in a consecutive series of diabetics treated with (ITD) or without (NITD) insulin. Methods: Retrospective analysis of a multicenter registry with 1,896 diabetics, of which 397 (20.9%) were from the ITD group and 1,499 from the NITD group. Major adverse cardiac and cerebrovascular events (MACCE) were compared between groups. results: The ITD group showed a higher rate of women and of patients with chronic renal failure, but showed less complex angiographic characteristics when compared to the NITD group, with fewer B2/C lesions, thrombus-containing lesions, occlusions and TIMI 0/1 flow prior to PCI. We treated 1.4 ± 0.7 vessels/patient with 1.3 ± 0.7 stents/patient in each group and the diameter and length of stents were not different between groups. Clinical in-hospital outcomes showed no differences regarding the occurrence of MACCE (3.

Section: Discussionmentioning

confidence: 76%

Intervenção coronária percutânea em diabéticos tratados com insulina

Farinazzo¹,

Cantarelli²,

Castello³

et al. 2013

“…The DESIRE registry published its overall long-term results 11 stratified by previous diabetes diagnosis. 12 In the latter study, major adverse cardiac events occurred in 9.8% of diabetic patients and in 7% of non-diabetics, at a mean follow-up of 2.5 ± 1.4 years (P = 0.05). The observed differences in the incidence of events between the two registries are related to the different event definitions adopted, differences in clinical and angiographic profile of patients, and different follow-up times.…”

Section: Discussionmentioning

confidence: 76%

“…16 The SAPPHIRE registry shows rates of major adverse cardiac events consistent with other registries. 12,17 According to the present results, it is concluded that the use of DES is of fundamental importance for the percutaneous treatment of coronary artery disease in diabetic patients, especially for those who do not use insulin, considering the reduction of risk of serious cardiac events to levels similar to those of non-diabetic patients.…”

Section: Table 3 Angiographic and Clinical Complications Inmentioning

confidence: 68%

Resultados iniciais e tardios de diabéticos tratados com stents farmacológicos do Registro Safira

Flávio

Marchini

Salman

et al. 2013

Background: The percutaneous treatment of coronary artery disease has been revolutionized by the use of drug-eluting stents (DES). However, its use in the daily practice involves patients with more complex clinical and angiographic characteristics than those found in randomized trials. This registry was designed to characterize diabetic patients and their outcomes following DES implantation in our country. Methods: Prospective single-center registry enrolling consecutive patients after DES implantation. Clinical, angiographic and procedurerelated data, as well as early and long-term outcomes were recorded. The primary endpoint, including cardiac death, myocardial infarction or target lesion revascularization, was compared between diabetics and non-diabetics. Results: We evaluated 1,670 patients treated with DES from 2002 to 2012 with a follow-up of 3.2 ± 2.5 years. One third of the patients were diabetic and had lower event-free survival when compared to non-diabetic patients (79.4% vs. 82.6%; P = 0.015). The adjusted odds ratio, however, was 1.22 (95% CI, 0.89-1.69) and was not significant. A significantly lower event-free survival was observed in the subgroup of patients receiving insulin, whereas it was similar for diabetic and nondiabetic patients in the subgroup not receiving insulin (68.7% vs. 83.9% vs. 82.8%, respectively; P < 0.01). The adjusted odds ratio was 1.72 (95% CI, 1.13-2.63) higher for diabetic patients receiving insulin when compared to the remaining patients.

“…The presence of a higher number of diabetic patients in the second study period has an additional association with the increased supply of pharmacological stents in this period, providing a more effective approach with lower rates of restenosis in this population. 14 The implementation of chest pain protocols in hospitals participating in the registry, with primary PCI availability 24 hours a day, may explain the growing number of this type of PCI in the present registry. Regarding the care of AMI, the rate of use of glycoprotein IIb/IIIa inhibitors remained stable and low (6.4 % to 7.5 %) during the study period, which has been a trend in literature since the advent of clopidogrel, new antiaggregants, and the use of thrombus aspiration catheters 12 The more frequent use of aspiration catheters in the second period group coincides with the publication, in 2008, of the TAPAS trial results, which showed the superiority of thrombus aspiration technique to treat AMI with ST-segment elevation, reducing cardiac mortality combined with non fatal reinfarction within one year.…”

Section: Discussionmentioning

confidence: 92%

Mudanças no perfil populacional e resultados da intervenção coronária percutânea do Registro Angiocardio

Farinazzo¹,

Cantarelli²,

Castello³

et al. 2013

Background: Technological developments have enabled the expansion of percutaneous coronary intervention (PCI) indications for more challenging clinical and angiographic scenarios. Our objective was to evaluate the results of PCI in two different periods in the past 6 years. Methods: This was a multicenter registry including 6,288 consecutive patients treated by PCI, who were divided according to different treatment periods: 2006 to 2008 (P1; n = 1,779) and 2009 to 2012 (P2; n = 4,509). We intended to compare the rates of in-hospital major adverse cardiac and cerebrovascular events (MACCE) and identify their predictors. Results: P2 patients were younger and had a higher prevalence of smoking and diabetes. These patients had a greater rate of multivessel, thrombotic and bifurcation lesions. The number of diseased vessels per patient was higher in the P2 Group, as well as the number of stents per patient, and the use of drug-eluting stents. MACCE was more frequent in P2 patients (2.5% vs. 3.5%; P = 0.04), due to periprocedural myocardial infarction (1.7% vs. 2.6%; P = 0.05), and there were no differences in terms of death (1.0% vs. 1.0%; P = 0.87), stroke (0.2% vs. 0.1%; P = 0.47) or emergency coronary artery bypass grafting (0.1% vs. 0; P = 0.68).