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This study sought to evaluate the safety and efficacy of drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients with insulin- and noninsulin-treated diabetes.Diabetes is a powerful predictor of adverse events after percutaneous coronary interventions (PCI), and insulin-treated diabetic patients have worse outcomes. The DES are efficacious among patients with diabetes; however, their safety and efficacy, compared with BMS, among insulin-treated versus noninsulin-treated diabetic patients is not well established.Using the National Heart, Lung, and Blood Institute Dynamic Registry, we evaluated 1-year outcomes of insulin-treated (n = 817) and noninsulin-treated (n = 1,749) patients with diabetes who underwent PCI with DES versus BMS.The use of DES, compared with BMS, was associated with a lower risk for repeat revascularization for both noninsulin-treated patients (adjusted hazard ratio [HR] = 0.59, 95% confidence interval [CI] 0.45 to 0.76) and insulin-treated subjects (adjusted HR = 0.63, 95% CI 0.44 to 0.90). With respect to safety in the overall diabetic population, DES use was associated with a reduction of death or myocardial infarction (adjusted HR = 0.75, 95% CI 0.58 to 0.96). However, this benefit was confined to the population of noninsulin-treated patients (adjusted HR = 0.57, 95% CI 0.41 to 0.81). Among insulin-treated patients, there was no difference in death or myocardial infarction risk between DES- and BMS-treated patients (adjusted HR = 0.95, 95% CI 0.65 to 1.39).Drug-eluting stents are associated with lower risk for repeat revascularization compared with BMS in treating coronary artery disease among patients with either insulin- or noninsulin-treated diabetes. In addition, DES use is not associated with any significant increased safety risk compared with BMS. These findings suggest that DES should be the preferred strategy for diabetic patients.

ObjectivesWe sought to determine whether poorer outcomes in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (MI) during off-hours are related to delays in treatment, circadian changes in biology, or differences in operator-related quality of care.BackgroundPrevious investigation has suggested that patients undergoing primary PCI during off-hours are more likely to have adverse cardiac events than routine-hours patients, but the reasons for this remain poorly defined.MethodsClinical, angiographic, and procedural characteristics were compared in consecutive patients (n = 685) undergoing primary PCI in the National Heart, Lung, and Blood Institute Dynamic Registry between 1997 and 2006 that were classified as occurring during routine-hours (07:00 to 18:59) or off-hours (19:00 to 06:59). The primary end points were in-hospital death, MI, and target vessel revascularization.ResultsMedian time from symptom onset to PCI was similar (off-hours 3.4 h vs. routine-hours 3.3 h). Patients presenting in off-hours were more likely to present with cardiogenic shock and multivessel coronary artery disease but were equally likely to present with complete occlusion of the infarct-related artery. Procedural complications including dissection were more frequent in off-hours patients. In-hospital death, MI, and target vessel revascularization were significantly higher in off-hours patients (adjusted odds ratio [OR]: 2.66, p = 0.001), and differences in outcomes were worse even if the procedure was immediately successful (adjusted OR: 2.58, p = 0.005, adjusting for angiographic success). Patients undergoing PCI on weekends had better outcomes during the daytime than nighttime.ConclusionsPatients undergoing primary PCI for acute MI during off-hours are at significantly higher risk for in-hospital death, MI, and target vessel revascularization. These findings appear related to both diurnal differences in presentation and lesion characteristics, as well as differences in procedural complication and success rates that extend beyond differences in symptom-to-balloon time.

Additional file 1. Email Survey of Physical Therapists.

Home exercise instructional pamphlet given to all subjects randomized in the TeMPO Trial. The pamphlet provides a detailed overview of the home exercise program with specific instructions regarding progression of exercise difficulty and knee pain while exercising. Each exercise to be completed is then broken down into step-by-step instructions with accompanying images. The home exercise program instructions are also available in a video format with the link provided in the home exercise instructional pamphlet. (PDF 1791 kb)

Home exercise instructional pamphlet given to all subjects randomized in the TeMPO Trial. The pamphlet provides a detailed overview of the home exercise program with specific instructions regarding progression of exercise difficulty and knee pain while exercising. Each exercise to be completed is then broken down into step-by-step instructions with accompanying images. The home exercise program instructions are also available in a video format with the link provided in the home exercise instructional pamphlet. (PDF 1791 kb)

Contains screenshots demoing the placebo manual therapy components of Arm III of the TeMPO trial. The potential procedures detailed are: Therapist Guided Hip Internal/External Rotation and Ankle Plantar/Dorsi Flexion and Inversion/Eversion. (DOCX 5028 kb)

The exhaustive list of strengthening exercises with accompanying descriptions/instructions that could be performed under therapist supervision in the Arm IV in-clinic strengthening arm of the TeMPO trial. (DOCX 55 kb)

Contains screenshots demoing the placebo manual therapy components of Arm III of the TeMPO trial. The potential procedures detailed are: Therapist Guided Hip Internal/External Rotation and Ankle Plantar/Dorsi Flexion and Inversion/Eversion. (DOCX 5028 kb)

Additional file 1. Email Survey of Physical Therapists.