Background: Diabetes Mellitus has been known to be a risk factor for in-stent restenosis (ISR) after percutaneous coronary intervention (PCI). Also, long coronary lesion is the risk factor for ISR and adverse cardiac events after PCI. However, the safety and efficacy of drug-eluting stents (DES) in long coronary lesion in diabetic patients with acute myocardial infarction (MI) has not been sufficiently evaluated.
Methods: We compared of short-term and long-term outcomes between Sirolimus-eluting stents (SES) (n=284) and Paclitaxel-eluting stents (PES) (n=160) for long coronary lesion (≥ 30 mm) in diabetic patients with acute MI who were enrolled in Korean Acute MI Registry (KAMIR) and followed-up at least one year.
Results: The baseline clinical characteristics of both groups were similar except that SES group had higher serum creatine level (1.5±2.1 vs. 1.2±0.7 mg/dL, p=0.010). Angiographically, SES group involved more left anterior descending artery (55.3 % vs. 45.0 %, p=0.037) and had longer lesion length (33.5±3.2 vs. 32.5±2.8 mm, p=0.002). PES group involved more right coronary artery (43.8 % vs. 31.7 %, p=0.011) . At one-month, total major adverse cardiac events (MACEs) (10.0 % vs. 7.5 %, p=0.385) were similar between two groups. At 12-month, total MACEs (21.8 % vs. 19.4 %, p=0.541), re-PCI (10.9 % vs. 9.4 %, p=0.609), and target lesion revascularization (TLR) (3.9 % vs. 3.1 %, p=0.680) were similar between two groups. Multi-vessel involvement (OR=1.92, 95 % CI: 1.19-3.11, p=0.008), post-procedural TIMI flow grade < 3 (OR=2.33, 95 % CI: 1.19-4.56, p=0.013), lower ejection fraction (OR=0.97, 95 % CI: 0.95-0.99, p=0.004) were the independent predictors of one-year MACEs by Cox proportional hazard model. Stent type and angiographic lesion characteristics did not predict one-year MACEs.
Conclusions: SES and PES had similar short- and long-term outcomes in diabetic patients with acute MI who had long coronary lesion. Multi-vessel involvement, lower post-procedural TIMI flow grade, and lower ejection fraction were the risk factors of one-year MACEs.
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