The Impact of Diabetes Mellitus on Clinical Outcomes after Percutaneous Coronary Intervention with Different Stent Sizes

Mohammad Javad Zibaeenezhad; Mehrab Sayadi; Seyyed Saeed Mohammadi; Soorena Khorshidi; Ehsan Hadiyan; Neda Rasouli; Ali  Karimi-Akhormeh; Iman  Razeghian-Jahromi

doi:10.18502/jthc.v17i4.11609

Mohammad Javad Zibaeenezhad Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Mehrab Sayadi Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Seyyed Saeed Mohammadi Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Soorena Khorshidi Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Ehsan Hadiyan Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Neda Rasouli University of Colorado, School of Medicine, and VA Eastern Colorado Health Care System, Aurora, Colorado, USA.
Ali Karimi-Akhormeh Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Iman Razeghian-Jahromi Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

DOI: https://doi.org/10.18502/jthc.v17i4.11609

Keywords: Diabetes mellitus; Myocardial infarction; Percutaneous coronary intervention; Stents

Abstract

Background: This study aimed to investigate the possible relationship between different stent sizes and clinical outcomes after percutaneous coronary intervention (PCI) in patients with diabetes treated with drug-eluting stents (DESs) and dual antiplatelet therapy (DAPT).

Methods: Patients with stable coronary artery disease undergoing elective PCI with the DES were entered into a retrospective cohort between 2003 and 2019. Major adverse cardiac events (MACE), defined as the combined endpoint of revascularization, myocardial infarction, and cardiovascular death, were recorded. The participants were categorized according to the stent size: 27 mm for length and 3 mm for diameter. DAPT (aspirin and clopidogrel) was used for at least 2 years for diabetics and 1 year for nondiabetics. The median duration of follow-up was 74.7 months.

Results: Out of 1630 participants, 29.0% had diabetes. The diabetics constituted 37.8% of those with MACE. The mean diameter of the stents in the diabetics and nondiabetics was 2.81±0.29 mm and 2.90±0.35 mm, respectively (P>0.05). The mean stent length was 19.48±7.58 mm and 18.92±6.64 mm in the diabetics and nondiabetics, respectively (P>0.05). After adjustments for confounding variables, MACE was not significantly different between the patients with and without diabetes. Although MACE incidence was not affected by stent dimensions in the patients with diabetes, the nondiabetic patients implanted with a stent length exceeding 27 mm experienced MACE less frequently.

Conclusion: Diabetes did not influence MACE in our population. Additionally, stents of different sizes were not associated with MACE in patients with diabetes. We propose that using the DES supplemented by long-term DAPT and tight control of glycemic status after PCI could decrease the adverse consequences of diabetes.