Highlights
- •Usefulness of routine angiographic follow-up (RAF) in diabetes is less well known.
- •RAF cause increased incidence of revascularization and major adverse cardiac events.
- •Target lesion revascularization also higher in second-generation drug-eluting stents.
Abstract
Aims
The usefulness of routine angiographic follow-up (RAF) and clinical follow-up (CF)
after percutaneous coronary intervention (PCI) in patients with diabetes is not well
understood. We compare 3-year clinical outcomes of RAF and CF in diabetic patients
underwent PCI with drug-eluting stents (DES).
Methods
A total of 843 patients with diabetes who underwent PCI with DES were enrolled. RAF
was performed at 6–9 months after PCI (n = 426). Rest of patients were medically managed
and clinically followed (n = 417); symptom-driven events were captured. After propensity
score matched analysis, 2 propensity-matched groups (262 pairs, n = 524, C-statistic = 0.750)
were generated. The primary endpoint was major adverse cardiac events (MACE), the
composite of total death, non-fatal myocardial infarction (MI), target lesion revascularization
(TLR), target vessel revascularization (TVR), non-target vessel revascularization
(Non-TVR).
Results
During the 3-year follow-up period, the cumulative incidence of target lesion revascularization
[TLR: hazard ratio (HR), 4.07; 95% confidence interval (CI), 1.18–9.34; p = 0.001],
target vessel revascularization (TVR: HR, 4.02; 95% CI, 1.93–8.40; p < 0.001), non-TVR
(HR, 4.92; 95% CI, 1.68–14.4; p = 0.004) and major adverse cardiac events (MACE: HR,
2.53; 95% CI, 1.60–4.01, p < 0.001) were significantly higher in the RAF group. However,
the incidence of total death, non-fatal MI were similar between the two groups.
Conclusions
RAF following index PCI with DES in patients with diabetes was associated with increased
incidence of revascularization and MACE without changes of death or re-infarction
rates and increased TLR and TVR rates in both first- and second-generation DES.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Diabetes Research and Clinical PracticeAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Authors/Task Force members, Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al.2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014;35:2541–619.
Shiomi H, Morimoto T, Kitaguchi S, Nakagawa Y, Ishii K, Haruna Y, et al., ReACT Investigators. The ReACT Trial: Randomized Evaluation of Routine Follow-up Coronary Angiography After Percutaneous Coronary Intervention Trial JACC Cardiovasc Interv 2017;10:109–17.
- Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.Diabetes Care. 2014; 27: 1047-1053
- Management of the patient with diabetes mellitus and myocardial infarction: clinical trials update.Am J Med. 2004; 116: 47s-63s
- Randomized comparison of percutaneous coronary intervention with coronary artery bypass grafting in diabetic patients. 1-year results of the CARDia (Coronary Artery Revascularization in Diabetes) trial.J Am Coll Cardiol. 2010; 55: 432-440
- Diabetes mellitus and the clinical and angiographic outcome after coronary stent placement.J Am Coll Cardiol. 1998; 32: 1866-1873
- Randomized clinical trial of abciximab in diabetic patients undergoing elective percutaneous coronary interventions after treatment with a high loading dose of clopidogrel.Circulation. 2004; 110: 3627-3635
- Short- and long-term results after multivessel stenting in diabetic patients.J Am Coll Cardiol. 2004; 43: 1348-1354
Iijima R, Ndrepepa G, Mehilli J, Markwardt C, Bruskina O, Pache J, et al. Impact of diabetes mellitus on long-term outcomes in the drug-eluting stent era. Am Heart J 2007;154 688–93.
- Silent myocardial ischemia in asymptomatic patients with type 2 diabetes mellitus without previous histories of cardiovascular disease.Int J Cardiol. 2016; 216: 151-155
- Taskforce Team of Diabetes Fact Sheet of the Korean Diabetes Association. Improved trends in cardiovascular complications among subjects with type 2 diabetes in Korea: a nationwide study (2006–2013).Cardiovasc Diabetol. 2017; 16: 1
- Myocardial infarction redefined—a consensus document of the Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction.Eur Heart J. 2000; 21: 1502-1513
- Effect of Intravascular Ultrasound-Guided vs Angiography-Guided Everolimus-Eluting Stent Implantation: The IVUS-XPL Randomized Clinical Trial.JAMA. 2015; 314: 2155-2163
- Safety and efficacy of drug-eluting and bare metal stents: comprehensive meta-analysis of randomized trials and observational studies.Circulation. 2009; 119: 3198-3206
- A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease.N Engl J Med. 2004; 350: 221-231
- Impact of routine angiographic follow-up on the clinical benefits of paclitaxel-eluting stents: results from the TAXUS-IV trial.J Am Coll Cardiol. 2006; 48: 32-36
- Usage patterns and 2-year outcomes with the TAXUS express stent: results of the US ARRIVE 1 registry.Catheter Cardiovasc Interv. 2008; 72: 433-445
- Clinical restenosis after coronary stenting: perspectives from multicenter clinical trials.J Am Coll Cardiol. 2002; 40: 2082-2089
- ACC/AHA/SCAI, 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines.J Am Coll Cardiol. 2008; 51: 172-209
- Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology.Eur Heart J. 2005; 26: 804-847
- Impact of coronary lesion complexity on drug-eluting stent outcomes in patients with and without diabetes mellitus: analysis from 18 pooled randomized trials.J Am Coll Cardiol. 2014; 63: 2111-2118
- Efficacy and safety of everolimus and zotarolimus-eluting stents versus first-generation drug-eluting stents in patients with diabetes: a meta-analysis of randomized trials.Int J Cardiol. 2017; 230: 310-318
- Remodeling of in-stent neointima, which became thinner and transparent over 3 years: serial angiographic and angioscopic follow-up.Circulation. 1998; 97: 2003-2006
- Impact of routine angiographic follow-up after percutaneous coronary intervention with drug-eluting stents in the SPIRIT III randomized trial at three years.Am J Cardiol. 2012; 110: 21-29
- Impact of scheduled angiographic follow-up in patients treated with primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.J Interv Cardiol. 2013; 26: 319-324
- Clinical studies on coronary revascularization in patients with type 2 diabetes.Eur Heart J. 2003; 24: 1087-1103
Article info
Publication history
Published online: February 08, 2018
Accepted:
February 1,
2018
Received in revised form:
December 23,
2017
Received:
November 14,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
