Short- and long-term outcomes of diabetics and nondiabetics receiving bare-metal stents vs. drug-eluting stents: insights from the Dartmouth Dynamic Registry

Background: Shortand long-term outcomes of diabetics undergoing percutaneous coronary intervention (PCI) with placement of a drug-eluting stent(s) (DES) vs. a bare-metal stent(s) (BMS) remain a topic of debate. Methods: Using the Dartmouth Dynamic Registry, we evaluated the index in-hospital major adverse cardiovascular events (MACE-cardiac events, stroke, contrast-induced nephropathy, dialysis, death) and 3-year mortality trends among diabetics and nondiabetics who underwent PCI with either BMS or DES from January 2000 to June 2006. We excluded patients with prior PCI and patients with both BMS and DES. Results: Among the diabetics, 498 patients had BMSwhile 707 had DES; of the nondiabetics, 1664 had BMS while 1900 had DES. Diabetic and nondiabetic patients receiving DES were more likely to have hypertension. There were no other significant differences in baseline demographic and clinical variables. Diabetics had a 56% reduction in index admission MACE with DES [OR 0.44 (95% CI 0.28–0.65)], while nondiabetics had a 45% reduction in index admission MACE with DES [OR 0.55 (95% CI 0.43– 0.71)]. Three-year mortality trends are shown below. Conclusions: Diabetics and nondiabetics who underwent PCI with DES demonstrated significant improvements in MACE outcomes during their index admission. Long-term survival among nondiabetics post-PCI has significantly improved with DES compared to BMS, with a similar but nonsignificant trend seen among post-PCI diabetics with DES.