Safety and efficacy of everolimus-eluting stents versus paclitaxel-eluting stents in a diabetic population

• Published in: Catheterization and cardiovascular interventions 2013-04, Vol.81 (5), p.759-765
• Main Authors: Laynez, Ana, Sardi, Gabriel, Hauville, Camille, Barbash, Israel M., Pakala, Rajbabu, Torguson, Rebecca, Xue, Zhenyi, Satler, Lowell F., Pichard, Augusto D., Waksman, Ron
• Format: Article
• Language: English
• Subjects: Aged; Cardiovascular Agents - administration & dosage; Chi-Square Distribution; Coronary Angiography; Coronary Artery Disease - diagnosis; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; diabetes; Diabetic Angiopathies - diagnosis; Diabetic Angiopathies - mortality; Diabetic Angiopathies - therapy; Disease-Free Survival; District of Columbia; Drug-Eluting Stents; Everolimus; Everolimus-eluting stent; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction - etiology; Myocardial Infarction - prevention & control; Paclitaxel - administration & dosage; Paclitaxel-eluting stent; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - mortality; Platelet Aggregation Inhibitors - therapeutic use; Predictive Value of Tests; Proportional Hazards Models; Prosthesis Design; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Sirolimus - administration & dosage; Sirolimus - analogs & derivatives; Thrombosis - etiology; Thrombosis - prevention & control; Time Factors; Treatment Outcome; Ultrasonography, Interventional
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.24438

Objectives This study aimed to analyze the use of everolimus‐eluting stents (EES) and paclitaxel‐eluting stents (PES) in an unrestricted diabetic population and to compare the performance of these two drug‐eluting stents. Background EES have demonstrated superiority in efficacy when compared to PES in a general population. However, it is controversial whether this superiority holds true in a diabetic population. Methods From March 2004 to May 2010, 968 patients with consecutive diabetes who underwent percutaneous coronary intervention and implantation of an EES (n = 388) or PES (n = 580) at our institution. In‐hospital, 1‐month, 6‐month, and 1‐year clinical outcomes were analyzed and compared. Correlates of major adverse cardiac events (MACE) were identified. Results Baseline clinical characteristics were similar between stent types except for more family history of coronary artery disease in the PES group and more insulin‐dependent diabetes and unstable angina at initial diagnosis in the EES group. The PES group had higher number of lesions treated, longer stents used, and a higher proportion of intravascular ultrasound and glycoprotein IIb/IIIa inhibitor use. The EES group had more type C and distal lesions. There was higher target lesion revascularization (TLR)‐MACE in the PES group (3.3% vs. 1.0%, P = 0.03) as well as a higher rate of stent thrombosis (ST) (8 patients vs. 0 in the EES group, P = 0.03). ST continued to be higher in the PES group at 6 and 12 months and mortality was higher at 12 months in the PES group (9.4% vs. 5.2%, P = 0.02). After adjustment, no significant differences were found between stent types on Cox regression analysis for hazard ratios at 1‐year follow‐up of TLR‐MACE. Conclusions In a diabetic population undergoing PCI, the use of an EES compared to PES was associated with lower rates of stent thrombosis; but after adjustment the composite TLR‐MACE at 1 year was similar between both stents. © 2012 Wiley Periodicals, Inc.