title: The impact of preprocedural hemoglobin A1c on the efficacy of sirolimus-eluting and paclitaxel-eluting stents.
abstract: Several reports have shown contrary results regarding the efficacy of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in diabetic patients. The association between hemoglobin A1c (A1c) before coronary intervention and the midterm clinical outcomes of patients treated with these stents is unclear. The enrolled population was 415 patients with diabetes or impaired glucose tolerance (IGT) who underwent follow-up angiography after being implanted with a SES (n = 282) or PES (n = 133). The enrolled population was classified into the optimal glycemic control group (n = 213) and suboptimal glycemic control group (n = 202), and the predictors of restenosis were examined in each group. In the optimal glycemic control group, the use of PES was an independent predictor of restenosis [odds ratio (OR) 9.98, 95% confidence interval (CI) 3.08-38.9, p < 0.0001]; on the other hand, the use of SES was a positive independent predictor of restenosis prevention (OR 0.10, 95% CI 0.03-0.32, p < 0.0001). In the suboptimal glycemic control group, neither stent was predictive of restenosis. In a subanalysis, preprocedural A1c (≥7.0%) was found to be an independent predictor of restenosis in the SES group (OR 3.61, 95% CI 1.14-12.8, p = 0.03), but not the PES group. Postprocedural A1c (≥7.0%) was not an independent predictor of restenosis in either stent group. This study showed that the superiority of SES compared to PES was attenuated in the suboptimal glycemic control group. Preprocedural A1c (≥7.0%) was found to be an independent predictor of restenosis in the SES group, but not in the PES group.
authors.affiliation: Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan. tsawai@clin.medic.mie-u.ac.jp
authors.forename: Toshiki
authors.initials: T
authors.lastname: Sawai
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Miyahara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakajima
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakamori
authors.forename: Masataka
authors.initials: M
authors.lastname: Sakai
authors.forename: Hiroya
authors.initials: H
authors.lastname: Tamada
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanigawa
authors.forename: Norikazu
authors.initials: N
authors.lastname: Yamada
authors.forename: Mashio
authors.initials: M
authors.lastname: Nakamura
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000097:blood* / Q000000981:diagnostic imaging; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D003920:Diabetes Mellitus / Q000097:blood* / Q000000981:diagnostic imaging / Q000601:surgery; D054855:Drug-Eluting Stents; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D017239:Paclitaxel / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin; D017239:Paclitaxel; D020123:Sirolimus