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Clinical Impact of Second-Generation Everolimus-Eluting Stent Compared With First-Generation Drug-Eluting Stents in Diabetes Mellitus Patients Insights From a Nationwide Coronary Intervention Register

Author:
  • Elvin Kedhi
  • Marc E. Gomes
  • Bo Lagerqvist
  • Gustav Smith
  • Elmir Omerovic
  • Stefan James
  • Jan Harnek
  • Göran Olivecrona
Publishing year: 2012
Language: English
Pages: 1141-1149
Publication/Series: JACC: Cardiovascular Interventions
Volume: 5
Issue: 11
Document type: Journal article
Publisher: Elsevier

Abstract english

Objectives This study sought to study the second-generation everolimus-eluting stent (EES) as compared with first-generation sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) in diabetes mellitus (DM) patients. Background There are limited data available comparing clinical outcomes in this setting with EES and SES, whereas studies comparing EES with PES are not powered for low-frequency endpoints. Methods All DM patients treated with EES, PES, or SES from January 18, 2007, to July 29, 2011, from the SCAAR (Swedish Coronary Angiography and Angioplasty Registery) were included. The EES was compared with SES or PES for the primary composite endpoint of clinically driven detected restenosis, definite stent thrombosis (ST), and all-cause mortality. Results In 4,751 percutaneous coronary intervention-treated DM patients, 8,134 stents were implanted (EES = 3,928, PES = 2,836, SES = 1,370). The EES was associated with significantly lower event rates compared with SES (SES vs. EES hazard ratio [HR]: 1.99; 95% confidence interval (CI): 1.19 to 3.08). The same was observed when compared with PES (PES vs. EES HR: 1.33; 95% CI: 0.93 to 1.91) but did not reach statistical significance. These results were mainly driven by lower incidence of ST (SES vs. EES HR: 2.87; 95% CI: 1.08 to 7.61; PES vs. EES HR: 1.74, 95% CI: 0.82 to 3.71) and mortality (SES vs. EES HR: 2.02; 95% CI: 1.03 to 3.98; PES vs. EES HR: 1.69; 95% CI: 1.06 to 2.72). No significant differences in restenosis rates were observed between EES and SES or PES (SES vs. EES HR: 1.26; 95% CI: 0.77 to 2.08; PES vs. EES HR: 1.05; 95% CI: 0.71 to 1.55). Conclusions In all-comer DM patients the use of EES was associated with improved outcomes compared with SES and PES mainly driven by lower rates of ST and mortality. These results suggest better safety rather than efficacy with EES when compared with SES or PES. (J Am Coll Cardiol Intv 2012;5:1141-9) (C) 2012 by the American College of DM

Keywords

  • Cardiac and Cardiovascular Systems
  • all-cause mortality
  • condensed abstract
  • diabetes mellitus
  • everolimus-eluting stent
  • paclitaxel-eluting stent
  • restenosis
  • SCAAR
  • sirolimus-eluting stent
  • stent thrombosis

Other

Published
  • ISSN: 1876-7605
E-mail: gustav [dot] smith [at] med [dot] lu [dot] se

Associate professor

Cardiology

+46 46 17 26 33

D1232C

32

Research project participant

Cardiovascular Epigenetics

32

Research project participant

Heart Failure and Mechanical Support

32

Project manager

Molecular Epidemiology and Cardiology

+46 46 17 26 33

32

Lund University Diabetes Centre, CRC, SUS Malmö, Entrance 72, House 91:12. SE-205 02 Malmö. Telephone: +46 40 39 10 00