Clinical outcomes of contemporary drug‐eluting stents in patients with and without diabetes mellitus: Multigroup propensity‐score analysis using data from stent‐specific, multicenter, prospective registries

• Published in: Catheterization and cardiovascular interventions 2020-08, Vol.96 (2), p.243-252
• Main Authors: Kwon, Osung, Lee, Jung‐Bok, Ahn, Jung‐Min, Kang, Soo‐Jin, Lee, Seung‐Whan, Kim, Young‐Hak, Lee, Cheol Whan, Park, Seong‐Wook, Park, Duk‐Woo, Park, Seung‐Jung
• Format: Article
• Language: English
• Subjects: Aged; Biodegradability; Chromium; Clinical outcomes; Cobalt; coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Death; Diabetes; Diabetes mellitus; Diabetes Mellitus - diagnosis; Diabetes Mellitus - drug therapy; Diabetes Mellitus - mortality; Drug-Eluting Stents; Female; Heart; Heart attacks; Humans; Hypoglycemic Agents - therapeutic use; Implants; Insulin - therapeutic use; Male; Middle Aged; Myocardial infarction; Patients; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - mortality; Platinum; Polymers; Prospective Studies; Rapamycin; Registries; Risk Assessment; Risk Factors; Stents; Time Factors; Treatment Outcome
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.28462

Background Whether the diabetic status differentially affects the clinical outcomes with different drug‐eluting stents (DES) has been controversial. Methods and Results From stent‐specific, prospective DES registries, we evaluated 17,184 patients (11,428 in non‐diabetics and 5,756 in diabetics) who received several contemporary DES: 3570 sirolimus‐eluting stents (SES), 5,023 cobalt‐chromium everolimus‐eluting stents (CoCr‐EES), 2,985 platinum‐chromium EES (PtCr‐EES), 2,913 Resolute zotarolimus‐eluting stents (Re‐ZES), and 2,693 biodegradable‐polymer biolimus‐eluting stents (BP‐BES). The primary outcome was patient‐oriented composite endpoint (POCE, a composite of all‐cause death, any myocardial infarction, and any revascularization) at 3‐year follow‐up and target‐vessel failure (a composite of cardiac death, target‐vessel myocardial infarction, and target‐vessel revascularization) at 3 years was also evaluated. In non‐diabetics, the rates of POCE were not significantly different (CoCr‐EES 14.3%, PtCr‐EES 13.0%, Re‐ZES 14.3%, BP‐BES 13.4%, and SES 14.6%; overall p = .39). In diabetics, similar results were revealed (CoCr‐EES 18.4%, PtCr‐EES 20.3%, Re‐ZES 17.3%, BP‐BES 17.7%, and SES 17.8%; overall p = .44). In multiple treatment propensity‐score weighting analysis, regardless of the diabetic status, the hazard ratios for POCE between‐individual comparison were similar. Target‐vessel failure (a composite of cardiac death, target‐vessel myocardial infarction, and target‐vessel revascularization) was also comparable except the higher ratio of Re‐ZES than PtCr‐EES (hazard ratio 1.25, 1.26, 95% confidence interval 1.00–1.55, p = .048) in patients without diabetes. Conclusions In this clinical‐practice registry study, regardless the diabetic status, the 3‐year rates of the primary outcome were similar among different types of DES, suggesting no differential clinical response between contemporary DES in patients with or without diabetes.