Two-year clinical outcome after implantation of sirolimus-eluting and paclitaxel-eluting stents in diabetic patients.
OBJECTIVE
Percutaneous coronary intervention (PCI) in diabetic patients is associated with an increased risk of restenosis and major adverse cardiac events (MACE). We assessed the impact of diabetes on long-term outcome after PCI with sirolimus-eluting (SES) and paclitaxel-eluting (PES) stents.


RESULTS
In the SIRTAX trial, 1012 patients were randomized to treatment with SES (n = 503) or PES (n = 509). A stratified analysis of outcomes was performed according to the presence or absence of diabetes. Baseline characteristics were well balanced between SES and PES in patients with (N = 201) and without diabetes (N = 811). Clinical outcome was worse in diabetic compared with non-diabetic patients regarding death (9.0% vs. 4.1%, P = 0.004) and MACE (defined as cardiac death, myocardial infarction, or TLR; 19.9% vs. 12.7%, P = 0.007) at 2 years. Among diabetic patients, SES reduced MACE by 47% (14.8% vs. 25.8%, HR = 0.52, P = 0.05) and TLR by 61% (7.4% vs. 17.2%, HR = 0.39, P = 0.03) compared with PES at 2 years.


CONCLUSIONS
Diabetic patients have worse prognosis than non-diabetic patients undergoing PCI with DES. Among the diabetic patient population of this trial, SES reduce repeat revascularization procedures and MACE more effectively than PES and to a similar degree as in non-diabetic patients.
Billinger
Michael
M
Department of Cardiology, University Hospital Bern, 3010 Bern, Switzerland.
Beutler
Jonas
J
Taghetchian
Keywan R
KR
Remondino
Andrea
A
Wenaweser
Peter
P
Cook
Stéphane
S
Togni
Mario
M
Seiler
Christian
C
Stettler
Christoph
C
Eberli
Franz R
FR
Lüscher
Thomas F
TF
Wandel
Simon
S
Jüni
Peter
P
Meier
Bernhard
B
Windecker
Stephan
S
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D023903:Coronary Restenosis / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000379:methods; D017239:Paclitaxel / Q000008:administration & dosage*; D020123:Sirolimus / Q000008:administration & dosage*; D016896:Treatment Outcome; D050257:Tubulin Modulators / Q000008:administration & dosage*
D050257:Tubulin Modulators; D017239:Paclitaxel; D020123:Sirolimus