Differences in restenosis rate with different drug-eluting stents in patients with and without diabetes mellitus: a report from the SCAAR (Swedish Angiography and Angioplasty Registry).
OBJECTIVE
Our aim was to evaluate restenosis rate of drug-eluting stents (DES) in patients with and without diabetes mellitus (DM) in a real-world setting.


BACKGROUND
DES seem less effective in patients with DM.


METHODS
The SCAAR (Swedish Coronary Angiography and Angioplasty Registry) includes all patients undergoing percutaneous coronary intervention in Sweden. From April 1, 2004, to April 20, 2008, all restenoses detected at a subsequent angiography and all DES types implanted at more than 500 occasions were assessed using Cox regression.


RESULTS
Four DES types qualified for inclusion. In total, 35,478 DES were implanted at 22,962 procedures in 19,004 patients and 1,807 restenoses were reported over a mean 29 months follow-up. In the entire population, the restenosis rate per stent was 3.5% after 1 year and 4.9% after 2 years. The adjusted risk of restenosis was higher in patients with DM compared with that in patients without DM (relative risk [RR]: 1.23, 95% confidence interval [CI]: 1.10 to 1.37). In patients with DM, restenosis was twice as frequent with the zotarolimus-eluting Endeavor stent (Medtronic, Minneapolis, Minnesota) compared with that in the other DES types. The Endeavor stent and the sirolimus-eluting Cypher stent (Cordis, Johnson & Johnson, Miami, Florida) had higher restenosis rates in patients with DM compared with those in patients without DM (RR: 1.77, 95% CI: 1.29 to 2.43 and RR: 1.25, 95% CI: 1.04 to 1.51). Restenosis rate with the paclitaxel-eluting Taxus Express and Liberté (Boston Scientific, Natick, Massachusetts) stents was unrelated to DM. Mortality did not differ between different DES.


CONCLUSIONS
Restenosis rate with DES was higher in patients with DM compared with that in patients without DM. There seem to be important differences between different brands of DES.
Fröbert
Ole
O
Department of Cardiology, Orebro University Hospital, Orebro, Sweden. ole.frobert@orebroll.se
Lagerqvist
Bo
B
Carlsson
Jörg
J
Lindbäck
Johan
J
Stenestrand
Ulf
U
James
Stefan K
SK
D000368:Aged; D016022:Case-Control Studies; D016001:Confidence Intervals; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000628:therapy; D023903:Coronary Restenosis / Q000453:epidemiology / Q000517:prevention & control*; D019992:Databases as Topic; D048909:Diabetes Complications / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D017239:Paclitaxel / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012042:Registries; D012306:Risk; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013548:Sweden / Q000453:epidemiology; D050257:Tubulin Modulators / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D050257:Tubulin Modulators; C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus