－ S 127 －
― 53 ―
Clinical outcomes of Diabetic and Nondiabetic Patients with Drug-Eluting Stents
인제대학교 의과대학 부산백병원 순환기내과
*조환진․서정숙․박성길․설상훈․양태현․김성만․김대경․김두일․김동수
Background : Patients with diabetes mellitus (DM) are at increased risk for repeat interventions and mortality after coronary stenting. The efficacy of drug-eluting stents (DES) to improve the outcomes of these patients is uncertain. Method and Result:
In the 608 patients treated with DES at our hospital between January, 2004 and June, 2005, 193 were diabetic (Non-insulin dependent DM ?NIDDM?, N = 178) and 415 were non-diabetic (non-DM). 516 patients were implanted with sirolimus-eluting stent (SES) and 92 patients were implanted with paclitaxel-eluting stent (PES). In-hospital, 1 month and 1 year clinical outcomes were compared between DM and non-DM group. Also clinical outcomes were compared between SES and PES group.
The baseline characteristics were similar, except for more women, hypertension and lower left ventricular ejection fraction in the DM group (p<0.05). At 1 month, DM patients had a higher incidence of major adverse cardiac events (MACE) defined as target lesion revascularization (TLR), non-fetal myocardiac infarction (MI) and all cause of death (6.3% vs 2.7%, p=0.03). At 1 year, DM patients had higher incidence of all cause of death (7.7% vs 3.1%, p=0.01), TLR (8.8% vs 3.6%, p=0.01) and MACE (19.2%
vs 8%, p<0.01) and showed a lower MACE free survival rate (81.8% vs 92.5%, p<0.01). Follow-up coronary angiography was performed in 127 DM patients and 289 non-DM patients (65.8% vs 69.6%, p=0.34). DM patients had a higher incidence of in-stent restenosis (ISR) (16.4% vs 7.2%, p<0.01). In patients without DM, PES group had higher 1 year all cause of death (2.1% vs 9.3%,p<0.01), TLR (2.7% vs 9.1%,p=0.01), MACE (6.6% vs 16.7%, p=0.01) and ISR (6.0% vs 15.4%, p=0.03). However, these differences were not found in DM patients. Conclusion : DM patients still showed poor clinical outcomes and higher restenosis rate in DES era. In patients without DM, SES was superior to PES in terms of clinical outcomes.
― 54 ―
Risk of In-stent Restenosis(ISR) in Patients with Metabilic Syndrome Undergone Percutaneous Coronary Intervention
부산대학교 의과대학 내과학교실, 순환기내과
*하재경․이한철․황기원․한동철․이동원․윤영권․김 준․김준홍․전국진․홍택종․신영우
Background : The consequences of metabolic syndrome on ISR in patients who undergo percutaneous coronary intervention (PCI) remain unknown. The aim of our study was to examine whether the presence of metabolic syndrome constitutes a risk factor for ISR. Method : This was an observational retrospective study including 153 patients(177 lesions) treated by PCI with bare metal stent and underwent follow-up coronary angiogram between January 2002 and December 2004. Patients were defined as having metabolic syndrome by presence of three or more of the following criteria: 1) triglyceride level ≥ 150 mg/dl; 2) HDL cholesterol level ≥ 40 mg/dl in men and
≥ 50 mg/dl in women; 3) systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 85 mmHg 4) BMI ≥ 25 kg/m2, 5) fasting glucose level ≥ 110 mg/dl or diabetes. Result : Overall follow-up duration was 209 days (metabolic syndrome present group 216.1 ± 79.4, metabolic syndrome absent group 202 ± 58.2 p=0.196). Baseline patient characteristics were similar in both group. Baseline angiographic characteristics are in the below table. Risk of ISR was similar in two group. (26.1% vs 19.3%, p=0.287) Conclusion : Patients undergoing bare metal stent implatation with metabolic syndrome had been shown to have higher trend of ISR , but occurrence of ISR was statistically no significant difference in two group. Comment : we are going to announce datas of PCI with drug eluting stent
N(patient/lesion) Metabolic syndrome present (69/84) Metabolic syndrome absent (84/93) P Value
Age(years) 59.9 ± 10.1 58.8 ± 11.0 0.503
Gender, Male (%) 58 70 0.085
Target artery (%) 41/21/38/0 54/16/26/4 0.082
LAD/LCx/RCA/RI
Pre-PCI RD (mm) 3.02 ± 0.49 3.02 ± 0.48 1.000
Pre-PCI MLD (mm) 1.06 ± 1.30 0.88 ± 0.39 0.253
Stent diameter (mm) 3.27 ± 0.41 3.38 ± 0.38 0.265
Stent length (mm) 21.75 ± 7.19 22.12 ± 6.25 0.708
ISR (%) 26.1 19.3 0.287
