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Stent fracture is associated with a higher mortality in patients with type-2 diabetes treated by implantation of a second-generation drug-eluting stent

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Abstract

Type 2 diabetes correlates with clinical events after the implantation of a second-generation drug-eluting stent (DES). The rate and prognostic value of stent fracture (SF) in patients with diabetes who underwent DES implantation remain unknown. A total of 1160 patients with- and 2251 without- diabetes, who underwent surveillance angiography at 1 year after DES implantation between June 2004 and August 2014, were prospectively studied. The primary endpoints included the incidence of SF and a composite major adverse cardiac event [MACE, including myocardial infarction (MI), cardiac death, and target-vessel revascularization (TVR)] at 1-year follow-up and at the end of follow-up for overall patients, and target lesion failure [TLF, including cardiac death, target vessel myocardial infarction (TVMI) and target lesion revascularization (TLR)] at the end of study for SF patients. In general, diabetes was associated with a higher rate of MACE at 1-year (18.4 vs. 12.9%) and end of follow-up (24.0 vs. 18.6%, all p < 0.001), compared with those in patients who did not have diabetes. The 1-year SF rate was comparable among patients with diabetes (n = 153, 13.2%) and non-diabetic patients (n = 273, 12.1%, p > 0.05). Diabetic patients with SF had a 2.6-fold increase of SF-related cardiac death at the end of study and threefold increase of re-repeat TLR when compared with non-diabetic patients with SF (5.9 vs. 2.2%, p = 0.040; 6.5 vs. 2.2%, p = 0.032), respectively. Given the fact that diabetes is correlated with increased MACE rate, SF in diabetic patients translates into differences in mortality and re-repeat TLR compared with the non-diabetic group.

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Acknowledgements

The authors thank Dr. Ling Lin, and registered research coordinators (Ms. Hai-Mei Xu and Ms. Yin-Yin Zhao), for help with data collection.

Funding

This study was funded by a grant from the National Natural Science Foundation of China (NSFC 91639303 and NSFC 91439118), and Jiangsu Provincial Special Program of Medical Science (BL2013001), Nanjing, Jiangsu, China.

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Authors and Affiliations

  1. Division of Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006, Nanjing, China

    Zhen Ge, Zhi-Zhong Liu, Jing Kan, Jun-Jie Zhang, Nai-Liang Tian, Fei Ye & Shao-Liang Chen

  2. Division of Cardiology, Jintan People Hospital, Jintan, China

    Sui-Ji Li

  3. Division of Cardiology, Zhangjiagang People Hospital, Jiangsu, China

    Xue-Song Qian

  4. Division of Cardiology, Yixin People Hospital, Wuxi, China

    Song Yang

  5. Emory College of Arts and Science, Emory University, Atlanta, GA, USA

    Meng-Xuan Chen

  6. Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA

    Tanveer S. Rab

Authors
  1. Zhen Ge
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  2. Zhi-Zhong Liu
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  12. Shao-Liang Chen
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Contributions

GZ and LZZ (who contributed same) analyzed and interpreted data and wrote and reviewed the drafts of the article. JK contributed to the statistical analyses and reviewed the final draft of the article. ZJJ, LSJ, TNL, YF, QXS, and YS contributed to the interventional procedures and data collection and reviewed the final draft of the article. CMX and RTS reviewed the final draft. CSL contributed to the design of this Study, guided the process of data analysis and interpretation, and read and reviewed the drafts of the article. CSL is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Shao-Liang Chen.

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Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

The study involved human participants, all of the study participants had signed written informed consent for the procedure and the follow-up protocol.

Additional information

Zhen Ge and Zhi-Zhong Liu have contributed equally to this work.

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Ge, Z., Liu, ZZ., Kan, J. et al. Stent fracture is associated with a higher mortality in patients with type-2 diabetes treated by implantation of a second-generation drug-eluting stent. Int J Cardiovasc Imaging 33, 1873–1881 (2017). https://doi.org/10.1007/s10554-017-1194-z

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