title: Paclitaxel- versus sirolimus-eluting stents for treatment of ST-segment elevation myocardial infarction: with analyses for diabetic and nondiabetic subpopulation.
abstract: OBJECTIVE
  The aim of this study was to determine which drug-eluting stent (DES) is preferable for the treatment of ST-segment elevation myocardial infarction (STEMI) and to elucidate the impact of diabetes mellitus on the outcome of each DES.
  
  
  BACKGROUND
  Recent studies have shown the benefit of DES in patients with STEMI. Diabetes mellitus might differentially affect outcomes of each DES.
  
  
  METHODS
  We analyzed the large-scale, prospective, observational KAMIR (Korea Acute Myocardial Infarction Registry) study, which enrolled 4,416 STEMI patients (26% with diabetes) treated with paclitaxel-eluting stent (PES) or sirolimus-eluting stent (SES). Primary outcome was major adverse cardiac event (MACE), defined as a composite of mortality, nonfatal myocardial infarction, and target lesion revascularization (TLR).
  
  
  RESULTS
  In the overall population, the MACE rate at 1 year was significantly higher in the PES than the SES group (11.6% vs. 8.6%, p = 0.014), which was mainly due to increased TLR (3.7% vs. 1.8%, p < 0.001). In the diabetic subgroup, however, the MACE rate was not significantly different between PES and SES (14.5% vs. 12.3%, p = 0.217), in contrast to the nondiabetic subgroup, where PES was inferior to SES as in the overall population. Matching by propensity-score did not significantly alter these results. For TLR, there was interaction between the type of stents and diabetes mellitus (unadjusted: p = 0.052; after propensity-score matching: p = 0.035).
  
  
  CONCLUSIONS
  The PES was inferior to the SES in the overall population, with regard to the occurrence of MACE and TLR. However, subgroup analysis for diabetic subjects showed no differences in clinical outcomes between PES and SES. These results suggest that diabetes differentially affects the outcome of first-generation DES.
authors.affiliation: Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Youngjin
authors.initials: Y
authors.lastname: Cho
authors.forename: Han-Mo
authors.initials: HM
authors.lastname: Yang
authors.forename: Kyung-Woo
authors.initials: KW
authors.lastname: Park
authors.forename: Woo-Young
authors.initials: WY
authors.lastname: Chung
authors.forename: Dong-Joo
authors.initials: DJ
authors.lastname: Choi
authors.forename: Won-Woo
authors.initials: WW
authors.lastname: Seo
authors.forename: Kyoung-Tae
authors.initials: KT
authors.lastname: Jeong
authors.forename: Sung-Chul
authors.initials: SC
authors.lastname: Chae
authors.forename: Myoung-Yong
authors.initials: MY
authors.lastname: Lee
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Hur
authors.forename: Jei-Keon
authors.initials: JK
authors.lastname: Chae
authors.forename: In-Whan
authors.initials: IW
authors.lastname: Seong
authors.forename: Jung-Han
authors.initials: JH
authors.lastname: Yoon
authors.forename: Suk-Kyu
authors.initials: SK
authors.lastname: Oh
authors.forename: Doo-Il
authors.initials: DI
authors.lastname: Kim
authors.forename: Keum-Soo
authors.initials: KS
authors.lastname: Park
authors.forename: Seung-Woon
authors.initials: SW
authors.lastname: Rha
authors.forename: Yang-Soo
authors.initials: YS
authors.lastname: Jang
authors.forename: Jang-Ho
authors.initials: JH
authors.lastname: Bae
authors.forename: Taeg-Jong
authors.initials: TJ
authors.lastname: Hong
authors.forename: Myeong-Chan
authors.initials: MC
authors.lastname: Cho
authors.forename: Young-Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Myung-Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Min-Jung
authors.initials: MJ
authors.lastname: Kim
authors.forename: Sue K
authors.initials: SK
authors.lastname: Park
authors.forename: In-Ho
authors.initials: IH
authors.lastname: Chae
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D048909:Diabetes Complications; D054855:Drug-Eluting Stents; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000401:mortality; D006801:Humans; D007723:Korea; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage*; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D017239:Paclitaxel; D020123:Sirolimus