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document
Outcomes in patients with diabetes mellitus undergoing percutaneous coronary intervention in the current era : a report from the Prevention of REStenosis with Tranilast and its Outcomes ( PRESTO ) trial . BACKGROUND Diabetes portends an adverse prognosis in patients undergoing percutaneous coronary intervention ( PCI ) . Whether improvements in current clinical practice ( stents , IIb/IIIa antagonists ) have resulted in substantial improvement of these outcomes remains an issue . The aim of this study was to determine the influence of diabetes on 9-month outcomes of patients undergoing PCI in the current era . METHODS AND RESULTS The 11 482 patients enrolled in the Prevention of REStenosis with Tranilast and its Outcomes ( PRESTO ) Trial were stratified according to the presence ( n=2694 ) or absence ( n=8798 ) of diabetes . Diabetic patients were older ; were more likely to be female ; had a higher proportion of congestive failure , hypertension , prior CABG , and unstable angina ; and had higher body mass index and lower ejection fraction than nondiabetic patients ( P < 0.01 for all comparisons ) . The degree of multivessel disease was similar between the two groups . American College of Cardiology/American Heart Association type C lesions were more common in diabetic patients ( 17 % versus 15 % , P < 0.01 ) . Angiographic and procedural success rates and in-hospital events were similar between the two groups . The primary end point of death , myocardial infarction , or target vessel revascularization ( TVR ) was analyzed as time-to-first event within 9 months of the index PCI . After adjusting for certain baseline characteristics , diabetes was independently associated with death at 9 months ( relative risk [ RR ] , 1.87 ; 95 % CI , 1.31 to 2.68 , P < 0.01 ) and with an increased likelihood of TVR ( RR , 1.27 ; 95 % CI , 1.14 to 1.42 , P < 0.01 ) , as well as the composite end point of death/myocardial infarction/TVR ( RR , 1.26 ; 95 % CI , 1.13 to 1.40 , P < 0.01 ) . CONCLUSIONS Despite advances in interventional techniques , diabetes remains a significant independent predictor of adverse events in the intermediate term after PCI .
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Intervention_Surgical
percutaneous coronary intervention
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Intervention_Surgical
percutaneous coronary intervention ( PCI ) .
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Intervention_Surgical
PCI
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Intervention_Physical
Prevention of REStenosis with Tranilast and its Outcomes ( PRESTO ) Trial
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Intervention_Surgical
PCI
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Intervention_Surgical
PCI
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Outcome_Physical
congestive failure
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Outcome_Physical
hypertension
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Outcome_Physical
prior CABG
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Outcome_Physical
unstable angina
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Outcome_Physical
body mass index
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Outcome_Physical
ejection fraction
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Outcome_Physical
degree of multivessel disease
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Outcome_Physical
type C lesions
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Outcome_Other
Angiographic and procedural success rates
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Outcome_Other
in-hospital events
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Outcome_Mortality
death
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Outcome_Physical
myocardial infarction
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Outcome_Physical
target vessel revascularization ( TVR )
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Outcome_Mortality
death
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Outcome_Physical
TVR
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Outcome_Physical
death/myocardial infarction/TVR
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Participant_Condition
diabetes mellitus undergoing percutaneous coronary intervention
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Participant_Condition
undergoing percutaneous coronary intervention
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Participant_Condition
PCI
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Participant_Condition
undergoing PCI
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Participant_Sample-size
11 482