The long-term value of sirolimus- and paclitaxel-eluting stents over bare metal stents in patients with diabetes mellitus

• Published in: European heart journal 2007-01, Vol.28 (1), p.26-32
• Main Authors: Daemen, Joost, Garcia-Garcia, Hector M., Kukreja, Neville, Imani, Farshad, de Jaegere, Peter P.T., Sianos, Georgios, van Domburg, Ron T., Serruys, Patrick W.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Case-Control Studies; Coronary Restenosis - mortality; Coronary Restenosis - prevention & control; Diabetes Mellitus, Type 2 - mortality; Diabetes Mellitus, Type 2 - prevention & control; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - mortality; Diabetic Angiopathies - prevention & control; Drug Combinations; Drug Implants; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Follow-Up Studies; Humans; Immunosuppressive Agents - administration & dosage; Male; Medical sciences; Middle Aged; Paclitaxel - administration & dosage; Retrospective Studies; Sirolimus - administration & dosage; Stents; Survival Analysis
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehl412

Aims To investigate the outcome of a real world diabetic patient cohort treated with bare metal stents (BMS), sirolimus-, or paclitaxel-eluting stents (SES and PES, respectively). Due to the different mechanisms of action of both drugs it is currently unknown which device is the best option to treat these high-risk patients. Methods and results The study compares the 2-year clinical outcome of 708 consecutive diabetic patients (25% insulin treated) treated with either a BMS (n = 252), a SES (n = 206), or a PES (n = 250), as part of the RESEARCH and T-SEARCH registries. Target vessel revascularization was 19.5% in the BMS group, vs. 15.3% in the SES group and 9.7% in the PES group. PES (21.2%), but not SES (28.9%), were superior to BMS (29.7%) in reducing major adverse cardiac events. After propensity analyses, none of the differences remained significant. The incidence of stent thrombosis (ST) was high in both DES groups. Conclusion There was a trend towards a more favourable outcome associated with the use of PES over BMS. There was no significant difference between SES and PES in each of the clinical endpoints, and neither in the NIDDM patients, which are hypothesized to be better-off with PES.