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


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.


CONCLUSIONS
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.
Daemen
Joost
J
Thoraxcenter, Erasmus Medical Center, Ba-583 Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
Garcia-Garcia
Hector M
HM
Kukreja
Neville
N
Imani
Farshad
F
de Jaegere
Peter P T
PP
Sianos
Georgios
G
van Domburg
Ron T
RT
Serruys
Patrick W
PW
D016022:Case-Control Studies; D023903:Coronary Restenosis / Q000401:mortality / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000401:mortality / Q000517:prevention & control*; D004338:Drug Combinations; D004343:Drug Implants; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents; D016019:Survival Analysis
D004338:Drug Combinations; D004343:Drug Implants; D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus