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Diabetes Mellitus & Multi vessel disease-part 1
1. Diabetes And
Multivessel Disease
Dr. Dev Pahlajani
MD,FACC,FSCAI
Chief of Interventional Cardiology, Breach
Candy Hospital, Mumbai
www.cardiositeindia.com
3. The Diabetes Epidemic
• About 150 million diabetic patients worldwide, expected
to double by 2025
• One million new patients diagnosed in the US each year
• Prevalence in Europe ~5% to ~7%, expected to double
in next 25 years.
UK 3.1
Netherlands 3.6
Italy 7.1
Germany 4.2
France 4.0
Belgium 4.1
0.0 2.0 4.0 6.0 8.0
0-5% in Western Europe (%)
5-8% in Southern Europe
Amos AF et al. Diabetic Medicine 1997; 17: S7-S85
Mak KH et al. European Heart Journal 2003; 24: 1087-1103
IDF (International Diabetes Federation - 2000)
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4. WORLD CAPITAL OF DIABETES
India was the expected world capital of DM
China has overtaken India to wrest the title of the
‘diabetes capital of the world', going by the latest figures
revealed by the 5th edition of Diabetes Atlas
At 90.0 million, China today has the largest number of
people with diabetes.
India follows with about 61.3 million
The third on the list is far behind – United States at 23.7
million.
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5. Global Burden of Diabetes
Top 10 Countries With Diabetics (20-79 Years Of Age)
Country 2011 Country 2031
[Millions] [Millions]
China 90.0 China 129.7
India 61.3 India 101.2
USA 23.7 USA 29.6
Russian Federation 12.6 Brazil 19.6
Brazil 12.4 Bangladesh 16.8
Japan 10.7 Mexico 16.4
Mexico 10.3 Russian Federation 14.1
Bangladesh 8.4 Egypt 12.4
Egypt 7.3 Indonesia 11.8
Indonesia 7.3 Pakistan 11.4
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8. BYPASS ANGIOPLASTY REVASCULARISATION
INVESTIGATION (BARI)
New Engl Jour Of Med 1996 (335): 217-225
Comparison of Coronary Bypass Surgery with Angioplasty in
Patients with Multivessel Disease
914 assigned to CABG
915 assigned to PTCA
Similar
Demographic Features
Angiography Findings
EF
Equally Distributed Co morbid Features
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10. BARI study: Mortality in Diabetic Patients
o Benefit only in CABG patients with internal mammary
artery
o Greatest difference seen in diabetics treated with insulin
o Difference due to a reduced mortality in patients with a
subsequent AMI
“Diabetics with multi-vessel disease
should undergo CABG”
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11. BARI Registry: No Difference in Long-term Outcome in
Diabetics Treated by PTCA or CABG
“PTCA is a safe alternative to CABG in diabetics when they are
properly selected”
CABG Patients PTCA Patients
100 Registry (85.8) 100 Registry (86.1)
80 Randomized (84.4) 80 Randomized (80.9)
Survival (%)
Survival (%)
60 60
40 40
Unadjusted p=0.57 Unadjusted p<0.01
20 Adjusted p=0.66 20 Adjusted p=0.16
0 0
0 1 2 3 4 5 6 7 0 1 2 3 4 5 6 7
No. of patients No. of patients
Registry 625 590 569 436 Registry 1189 1124 1091 769
Random. 914 860 814 590 Random. 915 842 790 579
www.cardiositeindia.comF et al, Circulation 2000;101:2795
Feit
12. Cumulative Number of Subsequent Revascularization
Procedures per 100 Patients by Randomization
PCI
CABG PCI
CABG
www.cardiositeindia.com The BARI Investigators, J Am Coll Cardiol 2007;49:1600-1606
13. Overall Survival by Randomized
Treatment Stratified by Diabetes Status
The BARI Investigators, J Am Coll Cardiol 2007;49:1600-1606
www.cardiositeindia.com
14. Overall Survival and Survival Free of Q-
Wave MI by Randomized Treatment
www.cardiositeindia.com The BARI Investigators, J Am Coll Cardiol 2007;49:1600-1606
15. Rates of Survival and Freedom from Major Cardiovascular
Events, According to PCI and CABG Strata.
www.cardiositeindia.com Source: The BARI 2D Study Group. N Engl J Med 2009;360:2503-2515 .
16. 10-Year Survival Rates for Patients According
to Subgroups Based on Characteristics at
Study Entry
www.cardiositeindia.com The BARI Investigators, J Am Coll Cardiol 2007;49:1600-1606
17. Percent of Surviving Patients With Stable or
Unstable Angina at Each Follow-Up by
Randomization
The BARI Investigators, J Am Coll Cardiol 2007;49:1600-1606
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18. Freedom From Cardiac Death and Freedom From
Cardiac Death or Any MI by Randomized Treatment
www.cardiositeindia.com The BARI Investigators, J Am Coll Cardiol 2007;49:1600-1606
19. Diabetes is a Predictor of Late Loss
%
LL D
Trial mm M Late Loss vs. % of Diabetics in Bare (non-DES)
Sirius-Ctrl/8mo. 1 28.2 Stent Study
Ravel-Ctrl/6mo. 0.8 21
30
Venus-6mo 0.97 23.4 1
0.98
25
Velvet-6mo 0.7 10.7 0.830.97 1.19
0.8 0.93
% of Diabetics in the study
Vision-6mo 0.83 23 20
0.9
Penta-6mo 0.9 18.5 15 Series1
0.6
Multi-Link-ISAR2 0.54
10 0.7
-6mo 0.93 22
BX ISAR2 1.19 22.2 5
Bstent 0
Heprincoated 0.54 12.2 0 0.5 1 1.5
Deliver Bare 0.98 26.8 Late Loss in mm.
Orbit 0.6 13.3
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21. ARTS I
The primary objective of ARTS I was to compare intra-
coronary stenting to bypass surgery in patients with
multivessel disease
Effectiveness was measured in terms of Major Cardiac
and Cerebrovascular Events (MACCE) – free survival at
one year
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22. ARTS I – Patient Flow
STENT CABG
600 INTENTION TO TREAT 605
1 Medical Treatment only Medical Treatment only 3
Cross–over Cross-over
3 consent withdrawal 8 consent withdrawal
2 LM disease 8 exclusion criteria
6 19
1 inappropriate selection 1 miscommunication
1 QMI on waiting list
1 UAP on waiting list
3 urgent CABG 2 PTCA
13 10 elective CABG within hosp stay 2
within hosp stay
580 Successful treatment according to randomisation 581
(97%) (96%)
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23. ARTS I
MACCE (30 day follow-up)
CABG Stent
(605) (600)
Death 8+3* 1.8% 9 1.5%
CVA 7+1 * 1.3% 5 0.8%
AMI (Q) 13+4* 2.8% 15+1* 2.7%
Re-CABG 2 0.3% 12 2.0%
Re-PTCA 3 0.5% 10 1.7%
Total 41 6.8% 52 8.7%
*
Events prior to assigned treatment
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24. The Stent Era: ARTS I Study
• Less favorable long-term outcome with stenting in DM
• 1-year mortality rate: 6.4% vs. 3.1%
• Reduced rate of revascularization compared to balloon PTCA
100
Event-free survival (%)
95
90
85 88.4%
84.4%
80
75
76.2%
70
65 63.4%
60
0 60 120 180 240 300 360
Days after randomization
CABG: Non Diabetes CABG: Diabetes
Stent: Non Diabetes Stent: Diabetes Abizaid A. Circulation 2001;104:533
www.cardiositeindia.com
25. ARTS I DIABETICS
Death/CVA/MI/CABG/RE- PTCA
DIABETIC SUBGROUP
Repeat revascularization was higher in diabetic patients
randomized to the stent arm vs. CABG(42.9% VS 10.9%)
Compared to non diabetic patients(27.5% vs 8.4%)
Based on the available evidence, surgery should continue
to be viewed as the preferred therapy for diabetic
patients with multivessel disease when using bare metal
stents.
www.cardiositeindia.com JACC, 2005, 46, 575-81
27. ARTS Trial (CABG v. PCI)
Three year follow-up
100 PCI
Event Free Survival (%)
80 99.5% 97.5% 97.2% CABG 96.3%
98.5% 97.2% 96.4% 95.5%
60
40
20
p=0.08 Log Rank
Death p=0.09 Fisher
0
0 150 300 450 600 750 900 1050 1200
Days since randomization
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28. ARTS Trial (CABG v. PCI)
Three year Follow-up
100
Event Free Survival (%)
CABG
80
PCI
60
96.0% 91.2% 89.8% 88.8%
40 95.5% 90.3% 89.2% 87.0%
20
Death AMI CVA p=0.58 Log Rank
p=0.62 Fisher
0
0 150 300 450 600 750 900 1050 1200
Days since randomization
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29. ARTS Trial (CABG v. PCI)
Three year Follow-up
100 95.7%
Event Free Survival (%)
87.8%
90 85.0%
83.6%
91.8%
CABG
80
73.5%
70 69.5%
65.7%
60 PCI
p=0.005 Log Rank
Death AMI CVA CABG Re-PCI p=0.006 Fisher
50
0 150 300 450 600 750 900 1050 1200
Days since randomization
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30. ARTS Trial (CABG v. PCI)
Three year Follow-up (Diabetic subgroup)
100 CABG
Event Free Survival (%)
90 92.7%
80 Death, AMI, CVA
PCI = CABG
70
61.6%
60 PCI
CABG Re-PCI p=0.0001 Log Rank
50 p<0.0001 Fisher
0 150 300 450 600 750 900 1050 1200
Days since randomization
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31. ARTS I DIABETICS
Death/CVA/MI/CABG/RE- PTCA
DIABETIC SUBGROUP
• Repeat revascularization was higher in diabetic patients
randomized to the stent arm vs. CABG(42.9% VS 10.9%)
• Compared to non diabetic patients(27.5% vs 8.4%)
• Based on the available evidence, surgery should
continnue to be viewed as the preferred therapy for
diabetic patients with multivessel disease when using
bare metal stents.
www.cardiositeindia.com JACC, 2005, 46, 575-81
32. ARTS II
PRIMARY OBJECTIVE
To compare the effectiveness of coronary stent
implantation using the Sirolimus drug eluting Bx Velocity™
stent with that of surgery as observed in ARTS I
Effectiveness will be measured in terms of Major Cardiac
and Cerebrovascular Events (MACCE) – free survival at 30
days and six months
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33. Sirolimus Coating Modulates neointima
in 30-Day Porcine Coronary Model
Control + Sirolimus
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34. ARTS II: Study Design
Single arm, multicenter trial
607 patients in 45 centers from 19 countries
Main goal of the ARTS II trial is to demonstrate non-
inferiority in clinical effectiveness and cost-effectiveness with
the CYPHER® stent compared to the previous results of the
ARTS I trial
ARTS II ARTS I
Randomization
CYPHER ® CABG CROWN™ &
(n=607) (n=605) CrossFlex LC™
(n=600)
Serruys P. et al., JACC 2005 (Sunday March 6th); Oral Presentation.
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35. ARTS-II Trial
Historical Controls from ARTS I: 1202
607 patients with multivessel patients with multivessel coronary
coronary lesions lesions
26.2% diabetic 18.2% diabetic
28% 3 vessel disease
54% 3 vessel disease
7.5% type C lesions
13.9% type C lesions
Bare Metal
CABG Stent
Sirolimus-eluting stent
2.8 stents per patient
3.7 stents per patient
Avg total length: 48
Avg total length: 73 mm n = 602 mm
n = 607
n = 600
Endpoints:
Primary – Major adverse cardiac and cerebrovascular events (MACCE),
including death, cerebrovascular event, myocardial infarction,
and revascularization, at 1 year for the comparison of CABG treated
patients in the ARTS I trial with sirolimus-eluting stent patients
in the ARTS II trial
Secondary – MACCE at 30 days, 6 months, 3 and 5 years.
– Total cost at 30 days
– Cost, cost effectiveness, quality of life at six mo, and 1, 3, and 5
years www.cardiositeindia.com ACC 2005
36. ARTS II – Diabetic population (MACCE
at 1y)
ARTS II ARTS I (CABG) ARTS I (PCI)
Hierarchical MACCE up to 1 year
(n=159) (n=96) (n=112)
} }
Death (%) 2.5 3.1 6.3
CVA (%) 0.0 3.1 5.2 10.4 1.8
MI (%) 0.6 2.1 6.3
(re) CABG (%)
(re) PCI (%)
3.1
9.4 } 12.5 1.0
3.1 } 4.1 8.0
14.3
Any MACCE (%) 15.7 14.6 36.6
Significant difference in MACCE (p=<0.001) between ARTS II
and ARTS I (PCI)
No significant difference in MACCE (p=0.86) between ARTS II
and ARTS I (CABG)
www.cardiositeindia.com Morice M-C. EuroPCR 2005.
37. ARTS II - MACCE up to 1 year*
ARTS II ARTS I (CABG) ARTS I (PCI)
Hierarchical MACCE up to 1 year
(n=607) (n=602) (n=600)
} }
Death (%) 1.0 2.7 2.7
CVA (%) 0.8 3.0 1.8 8.0 1.8
MI (%) 1.2 3.5 5.0
(re) CABG (%)
(re) PCI (%)
2.0
5.4 } 7.4 0.7
3.0 } 3.7 4.7
12.3
Any MACCE (%) 10.4 11.6 26.5
More extensive disease in ARTS II
(% diabetes, 3-vessel involvement, lesions/patients) than ARTS I
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* Complete follow-up in 97% Morice M-C. EuroPCR 2005.
38. ARTS II : Event free survival
At one year, there was no difference in event-free survival between the
ARTS II SES group and the ARTS I CABG group. However, the ARTS II
group showed significantly higher rates of survival free from cardiac
death, MI, and reintervention than the ARTS I bare metal stent group. The
groups were not significantly different in the primary endpoint of survival
free from MACCE.
ARTS II : DES ARTS I : BMS ARTS I : CABG
100
80
P = < 0.001
60 P = 0.003
P = 0.46
91.5
90.7
92.0
96.9
78.1
40
95.9
73.7
89.5
88.5
20
0
Survival free from Survival free from Survival free from
Death/CVE/MI reintervention MACE
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40. ARTS II – Diabetic population
ARTS II ARTS I (CABG) ARTS I (PCI)
Lesion characteristics patients (159) patients (96) patients (112)
(main differences) lesions (568) lesions (290) lesions (309)
Lesion length > 20mm (%) 15 6 6
Calcified lesion (%) 33 15 13
Type C lesions (%) 17 8 7
# of lesions > 50% DS 3.6 ± 1.3 3.0 ± 1.1 2.9+1.2
# of treated lesions 3.2 ± 1.2 2.8 ± 0.8 2.5+1.1
Procedural characteristics
# of stents implanted 3.6 ± 1.5 - 3.0 ± 1.5
Total stent length (mm) 74 - 53
Range 12-179 - 14-165
More extensive disease in ARTS II diabetic patients than ARTS I CABG
www.cardiositeindia.com Morice M-C. EuroPCR 2005.
41. ARTS – 5 Yrs Outcome Major Adverse Cardiac Events
At 5 Years In Patients Without Diabetes Stratified
According To Treatment
STENT BYPASS
NON-DIABETIC NON-DIABETIC STENT VS
N = 488 N = 509 RELATIVE RISK CABG
N (%) N (%) (95% CI) p VALUE
(RE) CABG 46 (9.4) 5 (1.0) 9.60 (3.85 – 23.95) < 0.001
(RE) PTCA 105 (21.5) 41 (8.1) 2.67 (1.90 – 3.75) < 0.001
ANY REVASC- 134 (27.5) 43 (8.4) 3.25 (2.36 – 4.48) < 0.001
ULARISATION
ANY MACCE 189 (38.7) 108 (21.2) 1.83 (1.49 – 2.23) < 0.001
P. W. SERRUYS
www.cardiositeindia.com JACC 2005
42. ARTS II : Summary
• Among patients with multivessel coronary lesions, patients
treated with sirolimus eluting stents had significantly lower rates
of MACCE compared with a historical registry of similar patients
treated with bare metal stents and rates of MACCE statistically
equivalent to patients from the same registry treated with CABG.
• The majority of the differnce in MACCE between the ARTS II and
ARTS I BMS groups was driven by the increased need for repeat
revascularization in the bare metal stent group. The ARTS II group
had equal rates of revascularization to the ARTS I CABG group,
despite having increased length and complexity of lesions.
• While this historical registry comparison is promising and
statistical measures were used to adjust for co-founding
variables, a randomized trial is needed to adequately determine
the superiority of one therapy over another.
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43. Short & Long Term Results After
Multivessel Stenting In Diabetic
Patients
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44. Short & Long Term Results After
Multivessel Stenting In Diabetic Patients
• Prospective data base of CRF 1993-1999
• 689 consecutive patients
• 1639 stents
• 501 (1200 lesions) – no DM
• 102 (235 lesions) oral agents
• 86 (204 lesions) insulin
R. MEHRAN
www.cardiositeindia.com JACC 2004
45. MULTISTENTING IN DIABETICS
IN-HOSPITAL OUTCOMES OF PATIENTS /
LESIONS NO DM NIDDM IDDM
(N= 560/1428) (N = 114/284) (N = 81/213) p VALUE
ANGIOGRAPHIC
SUCCESS (%) 99.8 99.0 100 0.47
ABRUPT
CLOSURE (%) 1.3 0.4 0 0.13
QMI (%) 0 0 0 NA
NON QMI (%) 27 28 21 0.51
R. MEHRAN
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46. MULTIVESSEL STENTING IN DIABETICS
1.0
0.9
0.8
0.7
SURVIVAL
0.6
0.5
No DM P < 0.001
0.4
DM treated with oral agent
0.3
DM treated with Insulin
0.2
0.1
0
0 100 200 300 400
TIME IN DAYS R. MEHRAN ET AL
www.cardiositeindia.com JACC 2004, 43, 1348
47. MULTIVESSEL STENTING IN DIABETICS
1.0
0.9
0.8
EVENT FREE SURVIVAL
0.7
0.6
0.5
No DM P < 0.001
0.4
DM treated with oral agent
0.3
DM treated with Insulin
0.2
0.1
0
0 100 200 300 400
TIME IN DAYS R. MEHRAN ET AL
www.cardiositeindia.com JACC 2004, 43, 1348
48. Comparison of Outcome Using Sirolimus-
Eluting Stenting in Diabetic Versus Non
diabetic Patients With Comparison
of Insulin Versus Non-Insulin Therapy in
the Diabetic Patients
Ramon Kumar, MDa, Tobias T. Lee, MDa, Allen Jeremias, MDa,
Christopher P. Ruisi, MDa, Brett Sylvia, BSa, Jorge Magallon, MDa,
Ajay J. Kirtane, MDa, Brian Bigelow, MDa, Martin Abrahamson,
MDb, Duane S. Pinto, MDa, Kalon K.L. Ho, MD MSca, David J.
Cohen, MD, MSca, Joseph P. Carrozza, Jr., MDa, and Donald E.
Cutlip, MDa
Am J. Cardiol 2007;100:1187
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49. Comparison of Sirolimus Stent in DM
Vs NDM - Insulin VS Non Insulin
Therapy
• 297 pts. With DM
• 115 on Insulin
• 541 Non DM
• All received Sirolimus Stent
www.cardiositeindia.com Am.J.Card.2007
50. CAD / Insulin TREATED & Siro Stent Outcome
Nine-month clinical events :
diabetic versus non diabetic patients
Events Diabetes Mellitus P Value
Yes No
(n = 297) (n = 541)
MACEs 33 (11.8 %) 28 (5.6 %) 0.002
Cardiac death 5 (1.8 %) 6 (1.2 %) 0.80
www.cardiositeindia.com Am J. Cardiol 2007;100:1187
51. CAD / Insulin Treated & Siro Stent Outcome
Nine-month clinical events : insulin-treated patients versus
others
Events Insulin Therapy P Value
Yes No
(n = 115) (n = 182)
MACEs 19 (17.5 %) 14 (8.2 %) 0.001
Cardiac death 4 (3.7 %) 1 (0.6 %) 0.006
MI 9 (8.2 %) 8 (4.6 %) 0.06
Cardiac death or MI 11 (10.1 %) 9 (5.2 %) 0.01
TLR 14 (13.3 %) 12 (7.1 %) 0.04
Stent Thrombosis 3 (2.6 %) 3 (1.7 %) 0.57
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Am J. Cardiol 2007;100:1187
52. Influence of DM on Outcomes-ST in
Asian Patients
856 with DM
2295 no DM
All received DES
Death, Non fatal MI,TVR
Park et al Am.J.Card.2009,103,2079
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53. 40 4
Diabetes Diabetes
Non-diabetes Non-diabetes
30
Event rates (%)
Event rates (%)
2
Log Rank P=0.34 Log Rank P=0.34
20
1
10
0 0
0 365 730 1095 0 365 730 1095
No. at Risk
Follow-up (days) No. at Risk
Follow-up (days)
Diabetes 865 730 457 195 Diabetes 865 842 560 247
Non-diabetes 2295 2057 1339 561 Non-diabetes 2295 22487 1520 674
Kaplan-Meir survival curve of primary composite
end point and stent thrombosis
(definite or probable)
www.cardiositeindia.com Park et al Am J. Cardiol 2009, 103;646
54. Non-diabetics vs. insulin-treated diabetes
A Adjusted HR (95 % CI) P value
Death 2.77 (1.55-4.95) 0.001
MI 1.01 (0.54-1.89) 0.97
TLR 1.36 (0.77-2.39) 0.29
TVR 1.72 (1.02-2.88) 0.04
Death or MI 1.66 (1.09-2.53) 0.02
Death, MI or TVR 1.65 (1.17-2.32) 0.004
ST (decline or probable 0.99 (0.20-4.92) 0.99
ST (any ARC criteria) 1.75 (0.77-3.96) 0.20
0.1 1 10
Adjusted Hazard Ratio (95 % CI)
Adjusted hazard ratios for clinical outcomes
and stent thrombosis in diabetic patients who do
(A) and do not (B) require insulin therapy versus
non-diabetic patients
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Park et al Am j. Cardiol 2009, 103;646
55. Non-diabetics vs. Non insulin-treated diabetes
B Adjusted HR (95 % CI) P value
Death 0.66 (0.52-1.45) 0.58
MI 1.05 (0.74-1.49) 0.79
TLR 0.94 (0.67-1.32) 0.72
TVR 1.23 (0.91-1.67) 0.18
Death or MI 0.99 (0.74-1.31) 0.92
Death, MI or TVR 1.08 (0.87-1.35) 0.47
ST (decline or probable 0.62 (0.21-1.88) 0.40
ST (any ARC criteria) 0.74 (0.36-1.52) 0.41
0.1 1 10
Adjusted Hazard Ratio (95 % CI)
Adjusted hazard ratios for clinical outcomes
and stent thrombosis in diabetic patients who do
(A) and do not (B) require insulin therapy versus
non-diabetic patients
www.cardiositeindia.com Park et al Am j. Cardiol 2009, 103;646
62. ENDEAVOR IV: Diabetics vs Non-diabetics
Clinical Results to 12 months
Diabetes Non Diabetes
(477) (1071) P value
Death (all) - % (#) 0.4% 1.4% 0.171
Cardiac 0.4% 0.6% 1.000
MI (all) - % 0.9% 2.6% 0.030
Q Wave 0.0% 0.3% 0.557
Non Q Wave 0.9% 2.3% 0.063
Cardiac Death + All MI, % 1.3% 3.2% 0.035
Stent Thrombosis (all), % 0.7% 0.4% 0.444
TLR - % 6.4% 2.8% 0.002
TVR - % 9.0% 5.4% 0.012
MACE - % 7.0% 6.4% 0.651
TVF - % 9.6% 8.1% 0.367
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63. ENDEAVOR IV: Diabetics
TVF and TLR at 12 months
477 diabetics (30.8% of E IV patients)
P =0.53
Endeavor
10.8% P =0.43
8.6% 8.9% Taxus
P =0.70
7.4% 6.9%
5.8%
P =0.19
et a R
3.5%
2.1%
20/233 24/223 38/516 46/518 16/233 13/223 18/516 11/518
Diabetics Non-diabetics Diabetics Non-diabetics
TVF TLR
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64. DENDEAVOR IV:
Demographics: Diabetics vs Non Diabetics
Diabetics Non-Diabetics P value
(773) (775)
Age (yrs) 64.0 63.3 0.225
Male (%) 60.4 71.0 <0.001
History of Smoking (%) 54.1 64.8 <0.001
Family History CAD (%) 43.3 42.6 0.851
Diabetes (%) 100.0 0.0 N/A
IRDM (%) 30.2 0.0 <0.001
Hypertension (%) 90.6 76.8 <0.001
Hyperlipidemia (%) 87.0 81.3 0.007
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65. 1. The Endeavor stent is safe and effective in diabetic
patients with “workhorse lesions” (i.e., moderate lesion
complexity) compared to patients treated with the
TAXUS stent
2. Very long term safety surveillance will determine
whether very late stent thrombosis has been reduced
with the use of the Endeavor
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Point out the increasing number of diabetic patients. Endeavor trials also have less usage of IIbIIIa than other trials. Usage of IIbIIIa helps prevent acute and subacute stent thrombosis. Despite that Endeavor has less usage of IIbIIIa than other trials, the stent thrombosis rates are lower (total of only 4 patients to date in all trials).
The angio cohort of EII shows the same TLR results as the EIII trial. Remember EIII had 87% Angio FU in all patients (282/323)