Paclitaxel- versus sirolimus-eluting stents for treatment of ST-segment elevation myocardial infarction: with analyses for diabetic and nondiabetic subpopulation.
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.
Cho
Youngjin
Y
Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
Yang
Han-Mo
HM
Park
Kyung-Woo
KW
Chung
Woo-Young
WY
Choi
Dong-Joo
DJ
Seo
Won-Woo
WW
Jeong
Kyoung-Tae
KT
Chae
Sung-Chul
SC
Lee
Myoung-Yong
MY
Hur
Seung-Ho
SH
Chae
Jei-Keon
JK
Seong
In-Whan
IW
Yoon
Jung-Han
JH
Oh
Suk-Kyu
SK
Kim
Doo-Il
DI
Park
Keum-Soo
KS
Rha
Seung-Woon
SW
Jang
Yang-Soo
YS
Bae
Jang-Ho
JH
Hong
Taeg-Jong
TJ
Cho
Myeong-Chan
MC
Kim
Young-Jo
YJ
Jeong
Myung-Ho
MH
Kim
Min-Jung
MJ
Park
Sue K
SK
Chae
In-Ho
IH
Kim
Hyo-Soo
HS
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
D002317:Cardiovascular Agents; D017239:Paclitaxel; D020123:Sirolimus