Insulin-treated diabetes mellitus and predictors of mid-term clinical outcome after percutaneous coronary interventions with stent implantation.

BACKGROUND: Patients with type II, insulin-dependent diabetes mellitus have a high risk of death and repeat revascularization following successful percutaneous coronary interventions. The predictors of outcome in such patients after coronary stenting have not been clarified. METHODS: We studied 133 consecutive patients with type II, insulin-dependent diabetes mellitus who underwent coronary stenting from November 1992 to May 2001. The clinical outcome and predictors of major adverse cardiac events (MACE; that is death, myocardial infarction, target vessel revascularization) at follow-up were assessed. RESULTS: Out of 133 patients, 102 (76%) had multivessel (> or = 2 vessels) disease. Eight patients (6.0%) had in-hospital MACE. Clinical follow-up data at 19.5 months (range 6.1-100 months) were available for 121 (91%) patients. The MACE rate was 40.5%; 22 patients (18%) died, 17 (14%) of a cardiac death; 7 (5.8%) patients had a myocardial infarction, and target vessel revascularization was performed in 35 (28.9%) patients. At univariate analysis, hypertension (odds ratio-OR 5.5; confidence interval-CI 2.5-12.3; p < 0.001), hypercholesterolemia (OR 3.7; CI 1.7-8.2; p = 0.001), a prior percutaneous coronary intervention (OR 6.6; CI 2.9-15.4; p < 0.001), a prior myocardial infarction (OR 3.1; CI 1.5-6.7; p = 0.003) and the stent length (> or = 15 mm) (OR 2.7; CI 1.5-4.3; p = 0.008) were related to MACE. At multivariate analysis, hypertension (OR 4.1; CI 1.7-9.9; p = 0.002), a prior percutaneous coronary intervention (OR 4.8; CI 1.9-12; p = 0.001) and the stent length (OR 3.0; CI 1.3-7.4; p = 0.01) remained as independent predictors of MACE. CONCLUSIONS: Patients with insulin-dependent diabetes mellitus continue to face a high mortality and incidence of adverse events after stenting. The occurrence of events was related to a history including hypertension, percutaneous coronary interventions and to the stent length.