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TCT-65 Comparative Efficacy and Safety of Coronary Stents in Diabetic Patients With and Without Insulin Treatment: A pooled patient level analysis from 17 randomized trials
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016
CONCLUSION Procedural success was high and similar in patients with IS-CTO, as compared with de novo CTO. However, IS-CTO was independently associated with MACE (driven by TVR) on follow-up. CATEGORIES CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)
DIABETES MELLITUS AND PCI OUTCOMES Abstract nos: 65 - 68 TCT-65 Comparative Efficacy and Safety of Coronary Stents in Diabetic Patients With and Without Insulin Treatment: A pooled patient level analysis from 17 randomized trials Jaya Chandrasekhar,1 Bjorn Redfors,2 Philippe Généreux,3 Ajay Kirtane,4 Rupa Parvataneni,5 Roxana Mehran,6 Gregg Stone7 1 Mount Sinai Hospital, New York, New York, United States; 2CRF, New York, New York, United States; 3Columbia University Medical Center/ Hôpital du Sacré-Coeur de Montréal, New York, New York, United States; 4NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States; 5crf, new york, New York, United States; 6Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States; 7 Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States BACKGROUND Patients with diabetes mellitus (DM) have worse cardiovascular outcomes compared to non-DM patients. Whether DM patients treated with insulin (ITDM) have worse prognosis is unknown. METHODS In a pooled patient level analysis from 17 randomized PCI trials (n 21,830), we compared the 5-yr incidence of mortality, myocardial infarction (MI), stent thrombosis (ST) and target lesion revascularization (TLR) between ITDM and non-ITDM groups. Adjusted outcomes and multivariable predictors of 5-yr mortality were determined using study stratified Cox regression analysis. RESULTS The study population included 5281 patients (17.8%) with DM, of which 72.0% (3804) were non-ITDM and 28.0% were (1477) ITDM patients. ITDM patients were more likely to have prior revascularization and MI, and lower left ventricular ejection fraction than non-ITDM patients. ITDM patients had lesions with smaller reference vessel and final minimum lesion diameters than non-ITDM patients. The 5-yr adjusted risk of mortality was significantly higher in ITDM vs non-ITDM patients (Figure). The independent predictors of 5-yr mortality were age (HR 2.01 [1.76, 2.28]), current smoking (HR 2.28 [1.69, 3.07] per 10yr increase) and ITDM (HR 1.67 [1.32, 2.11]).
B27
Philippe Gabriel Steg,13 Annapoorna Kini,14 Bernhard Witzenbichler,15 Stuart Pocock,16 Roxana Mehran17 1 Mount Sinai Medical Center, New York, New York, United States; 2 Icahn School of Medicine at Mount Sinai; 3Mount Sinai Medical Center, New York, New York, United States; 4The Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, United States; 5San Raffaele Scientific Institute, Milan, Italy; 6San Raffaele Scientific Institute, Milan, Italy; 7Cedars Sinai Heart Institute, Los Angeles, California, United States; 8Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, United States; 9Shaare Zedek Medical Center, Jerusalem, Israel; 10Mount Sinai Medical Center, New York, New York, United States; 11Gibson Law Office, Dermott, United States; 12Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina, United States; 13Groupe Hospitalier Bichat – ClaudeBernard, Paris, France; 14Unknown, New York, New York, United States; 15Helios Amper-Klinikum, Dachau, Germany; 16London School of Hygiene and Tropical Medicine, London, United Kingdom; 17Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States BACKGROUND Early suspension of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) increases the risk of adverse cardiovascular events. However, how the risk varies according to DAPT cessation mode in patients with diabetes mellitus (DM) is unknown. We sought to examine the frequency and impact of different DAPT cessation patterns in DM patients after PCI with a DES. METHODS The PARIS registry is a multicenter, prospective, observational study comprising of 5031 patients undergoing PCI with at least one stent. DAPT cessation modes included: temporary interruption (<14 days), disruption due to bleeding or lack of compliance and physician-recommended discontinuation. RESULTS Among 4207 patients who received one or more DES, 1430 (34%) had DM. DM patients (70% men; 30% women) were older with higher prevalence of hypertension, dyslipidemia and prior coronary interventions compared to non-DM. At 2 years after PCI, DAPT cessation was less common in DM patients (50.2% vs 55.5%; p<0.01). Physician-recommended discontinuation was less frequent in DM (32.6% vs 39.6%; p<0.0001) compared to non-DM patients while frequency of other modes did not differ. In DM patients, only disruption increased the risk of cardiac death, myocardial infarction and MACE (composite of cardiac death, probable/definite stent thrombosis and MI), compared to uninterrupted DAPT (Figure). DAPT Interruption and discontinuation had no additional risk of clinical outcomes regardless of DM status. There were no differences in bleeding rates between the two groups.
CONCLUSION DAPT disruption due to adverse events or noncompliance within 2 years of PCI is associated with a significantly higher risk of all adverse events in DM patients compared to uninterrupted DAPT. Conversely, DAPT discontinuation and interruption carried no additional risk of clinical outcomes. CATEGORIES CORONARY: Pharmacology/Pharmacotherapy
CONCLUSION Among DM patients undergoing coronary stenting, insulin treatment is associated with significantly greater 5-yr mortality, but not MI, ST or TLR. CATEGORIES CORONARY: Diabetes TCT-66 Effects of dual antiplatelet therapy cessation among patients with diabetes mellitus after PCI with DES Michela Faggioni,1 Serdar Farhan,2 Usman Baber,3 Gennaro Giustino,4 Alaide Chieffo,5 Antonio Colombo,6 Timothy Henry,7 David Cohen,8 Giora Weisz,9 George Dangas,10 Charles Gibson,11 Mitchell Krucoff,12
TCT-67 Impact of the SYNTAX score in patients with diabetes and left-main and/or multivessel coronary disease: a pooled analysis of individual patient level data from the SYNTAX, PRECOMBAT and BEST trials Rafael Cavalcante,1 Yohei Sotomi,2 pannipa suwannasom,3 Cheol Whan Lee,4 Jung-Min Ahn,5 Erhan Tenekecioglu,6 Yaping Zeng,7 Carlos Collet,8 Yosuke Miyazaki,9 Yoshinobu Onuma,10 Seung-Jung Park,11 Patrick Serruys12 1 Thoraxcenter, Erasmus MC, Rotterdam, Netherlands; 2EMC, Rotterdam, Netherlands; 3Erasmus MC, rotterdam, Netherlands; 4Asan Medical Center, Seoul, Korea, Republic of; 5Asan Medical Center, Seoul, Korea, Republic of; 6ERASMUS MC, ROTTERDAM, Netherlands; 7Centro Cardiologico Monzino, Rotterdam, Netherlands; 8Clinica El Avila, Caracas, Venezuela; 9Erasmus MC, ROTTERDAM, Netherlands; 10 Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands;
CONCLUSION Procedural success was high and similar in patients with IS-CTO, as compared with de novo CTO. However, IS-CTO was independently associated with MACE (driven by TVR) on follow-up. CATEGORIES CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)
DIABETES MELLITUS AND PCI OUTCOMES Abstract nos: 65 - 68 TCT-65 Comparative Efficacy and Safety of Coronary Stents in Diabetic Patients With and Without Insulin Treatment: A pooled patient level analysis from 17 randomized trials Jaya Chandrasekhar,1 Bjorn Redfors,2 Philippe Généreux,3 Ajay Kirtane,4 Rupa Parvataneni,5 Roxana Mehran,6 Gregg Stone7 1 Mount Sinai Hospital, New York, New York, United States; 2CRF, New York, New York, United States; 3Columbia University Medical Center/ Hôpital du Sacré-Coeur de Montréal, New York, New York, United States; 4NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States; 5crf, new york, New York, United States; 6Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States; 7 Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States BACKGROUND Patients with diabetes mellitus (DM) have worse cardiovascular outcomes compared to non-DM patients. Whether DM patients treated with insulin (ITDM) have worse prognosis is unknown. METHODS In a pooled patient level analysis from 17 randomized PCI trials (n 21,830), we compared the 5-yr incidence of mortality, myocardial infarction (MI), stent thrombosis (ST) and target lesion revascularization (TLR) between ITDM and non-ITDM groups. Adjusted outcomes and multivariable predictors of 5-yr mortality were determined using study stratified Cox regression analysis. RESULTS The study population included 5281 patients (17.8%) with DM, of which 72.0% (3804) were non-ITDM and 28.0% were (1477) ITDM patients. ITDM patients were more likely to have prior revascularization and MI, and lower left ventricular ejection fraction than non-ITDM patients. ITDM patients had lesions with smaller reference vessel and final minimum lesion diameters than non-ITDM patients. The 5-yr adjusted risk of mortality was significantly higher in ITDM vs non-ITDM patients (Figure). The independent predictors of 5-yr mortality were age (HR 2.01 [1.76, 2.28]), current smoking (HR 2.28 [1.69, 3.07] per 10yr increase) and ITDM (HR 1.67 [1.32, 2.11]).
B27
Philippe Gabriel Steg,13 Annapoorna Kini,14 Bernhard Witzenbichler,15 Stuart Pocock,16 Roxana Mehran17 1 Mount Sinai Medical Center, New York, New York, United States; 2 Icahn School of Medicine at Mount Sinai; 3Mount Sinai Medical Center, New York, New York, United States; 4The Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, United States; 5San Raffaele Scientific Institute, Milan, Italy; 6San Raffaele Scientific Institute, Milan, Italy; 7Cedars Sinai Heart Institute, Los Angeles, California, United States; 8Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, United States; 9Shaare Zedek Medical Center, Jerusalem, Israel; 10Mount Sinai Medical Center, New York, New York, United States; 11Gibson Law Office, Dermott, United States; 12Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina, United States; 13Groupe Hospitalier Bichat – ClaudeBernard, Paris, France; 14Unknown, New York, New York, United States; 15Helios Amper-Klinikum, Dachau, Germany; 16London School of Hygiene and Tropical Medicine, London, United Kingdom; 17Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States BACKGROUND Early suspension of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) increases the risk of adverse cardiovascular events. However, how the risk varies according to DAPT cessation mode in patients with diabetes mellitus (DM) is unknown. We sought to examine the frequency and impact of different DAPT cessation patterns in DM patients after PCI with a DES. METHODS The PARIS registry is a multicenter, prospective, observational study comprising of 5031 patients undergoing PCI with at least one stent. DAPT cessation modes included: temporary interruption (<14 days), disruption due to bleeding or lack of compliance and physician-recommended discontinuation. RESULTS Among 4207 patients who received one or more DES, 1430 (34%) had DM. DM patients (70% men; 30% women) were older with higher prevalence of hypertension, dyslipidemia and prior coronary interventions compared to non-DM. At 2 years after PCI, DAPT cessation was less common in DM patients (50.2% vs 55.5%; p<0.01). Physician-recommended discontinuation was less frequent in DM (32.6% vs 39.6%; p<0.0001) compared to non-DM patients while frequency of other modes did not differ. In DM patients, only disruption increased the risk of cardiac death, myocardial infarction and MACE (composite of cardiac death, probable/definite stent thrombosis and MI), compared to uninterrupted DAPT (Figure). DAPT Interruption and discontinuation had no additional risk of clinical outcomes regardless of DM status. There were no differences in bleeding rates between the two groups.
CONCLUSION DAPT disruption due to adverse events or noncompliance within 2 years of PCI is associated with a significantly higher risk of all adverse events in DM patients compared to uninterrupted DAPT. Conversely, DAPT discontinuation and interruption carried no additional risk of clinical outcomes. CATEGORIES CORONARY: Pharmacology/Pharmacotherapy
CONCLUSION Among DM patients undergoing coronary stenting, insulin treatment is associated with significantly greater 5-yr mortality, but not MI, ST or TLR. CATEGORIES CORONARY: Diabetes TCT-66 Effects of dual antiplatelet therapy cessation among patients with diabetes mellitus after PCI with DES Michela Faggioni,1 Serdar Farhan,2 Usman Baber,3 Gennaro Giustino,4 Alaide Chieffo,5 Antonio Colombo,6 Timothy Henry,7 David Cohen,8 Giora Weisz,9 George Dangas,10 Charles Gibson,11 Mitchell Krucoff,12
TCT-67 Impact of the SYNTAX score in patients with diabetes and left-main and/or multivessel coronary disease: a pooled analysis of individual patient level data from the SYNTAX, PRECOMBAT and BEST trials Rafael Cavalcante,1 Yohei Sotomi,2 pannipa suwannasom,3 Cheol Whan Lee,4 Jung-Min Ahn,5 Erhan Tenekecioglu,6 Yaping Zeng,7 Carlos Collet,8 Yosuke Miyazaki,9 Yoshinobu Onuma,10 Seung-Jung Park,11 Patrick Serruys12 1 Thoraxcenter, Erasmus MC, Rotterdam, Netherlands; 2EMC, Rotterdam, Netherlands; 3Erasmus MC, rotterdam, Netherlands; 4Asan Medical Center, Seoul, Korea, Republic of; 5Asan Medical Center, Seoul, Korea, Republic of; 6ERASMUS MC, ROTTERDAM, Netherlands; 7Centro Cardiologico Monzino, Rotterdam, Netherlands; 8Clinica El Avila, Caracas, Venezuela; 9Erasmus MC, ROTTERDAM, Netherlands; 10 Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands;