699 J Chin Med Assoc 2003;66:699-708 Hsin-Bang Leu Ting-Yu Chiu Jaw-Wen Chen Tao-Chang Wu Phillip Yu-An Ding Mau-Song Chang Di vi sion of Car di ol ogy, De part ment of Med i cine, Tai pei Vet erans Gen eral Hos pi tal, and Car dio vas cu lar Re search Cen ter, Na tional Yang-Ming Uni ver sity School of Med i cine, Tai pei, Tai wan, R.O.C. Key Words coronary artery disease; coronary stenting; diabetes mellitus; plain old balloon angioplasty Orig i nal Article Acute and Late Clinical Outcomes of Coronary Balloon Angioplasty with or without Stenting in Diabetes – The Fact in The “Real World” Background. Di a be tes mellitus (DM) is one of the ma jor risk fac tors of cor o nary ar - tery disease (CAD). Both short- and long-term prognoses of plain old balloon angioplasty (POBA) are poorer in CAD pa tients with DM than in those with out. Re - cent ev i dence in di cates that cor o nary stenting sig nif i cantly im proves clin i cal re sults of POBA in CAD pa tients. How ever, the ben e fit of cor o nary stenting re mains con tro - ver sial in DM pa tients. The pur pose of this study was to eval u ate the acute and late clin i cal out comes of cor o nary stenting as com pared with POBA in di a betic pa tients with CAD in the real set ting of our daily prac tice. Methods. Be tween June 1997 and Sep tem ber 1998, more than 400 con sec u tive CAD pa tients re ceiv ing POBA with or with out cor o nary stenting were eval u ated. The pa - tients were those who had def i nite clin i cal di ag no sis of DM and re ceived cor o nary in - ter ven tion for the first time on their de novo, na tive le sion(s). Pa tients were di vided into 2 groups ac cord ing to POBA alone or bal loon di la ta tion fol lowed by cor o nary stenting. The im me di ate angiographic re sults and clin i cal out comes, in clud ing ma jor ad verse car dio vas cu lar events (MACE) as well as re cur rent an gina within 24 hours af ter the pro ce dure (acute) and more than 6 months (late) af ter the pro ce dure were eval u ated in the both groups of pa tients. Results. A to tal of 124 DM pa tients, aged 68 8 years with 85% male and 60% multivessel dis ease, were stud ied. There was no dif fer ence in base line de mo graphic data be tween those pa tients re ceiv ing POBA alone (POBA, n = 79) and in com bi na - tion with cor o nary stenting (stent, n = 45). The min i mal luminal di am e ter of the tar get le sion im me di ately af ter bal loon di la ta tion was smaller in the stent group than in POBA group (1.36 0.67 vs. 1.96 1.31 mm, p < 0.001). How ever, the fi nal luminal gain was much larger (1.60 0.64 vs. 0.80 0.88 mm, p < 0.001) and the acute event-free sur vival rate was higher (97.7% vs. 82.9%, p = 0.019) in stent group than in POBA group. While the percutaneous revascularization rate tended to be less in pa tients with stent than with POBA (31.8% vs. 49.3%, p = 0.08), the to tal late MACE rate was sim i lar be tween both groups (50% vs. 64.7%, p = NS). How ever, the late event-free sur vival rates were sig nif i cantly higher in stenting pa tients than in those with POBA (34.9% vs. 16.4%, p = 0.037). Con clu sions. Di a betic pa tients with sig nif i cant CAD were clin i cally found to be old and largely with multivessel disease for coronary intervention. The immediate angiographic re sults were better if treated with stenting than with POBA alone. Though the rate of late MACE was sim i larly high in both groups, cor o nary stenting ren dered a better acute event-free sur vival rate and es pe cially late event-free sur vival rate, sug gest ing its ben e fit for percutaneous cor o nary revascularization in di a betic patients. Re ceived: March 28, 2003. Ac cepted: September 12, 2003. Cor re spon dence to: Jaw-Wen Chen, MD, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan. Fax: +886-2-2871-1601