title: Clinical impact of second-generation everolimus-eluting stent compared with first-generation drug-eluting stents in diabetes mellitus patients: insights from a nationwide coronary intervention register.
abstract: OBJECTIVE
  This study sought to study the second-generation everolimus-eluting stent (EES) as compared with first-generation sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) in diabetes mellitus (DM) patients.
  
  
  BACKGROUND
  There are limited data available comparing clinical outcomes in this setting with EES and SES, whereas studies comparing EES with PES are not powered for low-frequency endpoints.
  
  
  METHODS
  All DM patients treated with EES, PES, or SES from January 18, 2007, to July 29, 2011, from the SCAAR (Swedish Coronary Angiography and Angioplasty Registery) were included. The EES was compared with SES or PES for the primary composite endpoint of clinically driven detected restenosis, definite stent thrombosis (ST), and all-cause mortality.
  
  
  RESULTS
  In 4,751 percutaneous coronary intervention-treated DM patients, 8,134 stents were implanted (EES = 3,928, PES = 2,836, SES = 1,370). The EES was associated with significantly lower event rates compared with SES (SES vs. EES hazard ratio [HR]: 1.99; 95% confidence interval (CI): 1.19 to 3.08). The same was observed when compared with PES (PES vs. EES HR: 1.33; 95% CI: 0.93 to 1.91) but did not reach statistical significance. These results were mainly driven by lower incidence of ST (SES vs. EES HR: 2.87; 95% CI: 1.08 to 7.61; PES vs. EES HR: 1.74, 95% CI: 0.82 to 3.71) and mortality (SES vs. EES HR: 2.02; 95% CI: 1.03 to 3.98; PES vs. EES HR: 1.69; 95% CI: 1.06 to 2.72). No significant differences in restenosis rates were observed between EES and SES or PES (SES vs. EES HR: 1.26; 95% CI: 0.77 to 2.08; PES vs. EES HR: 1.05; 95% CI: 0.71 to 1.55).
  
  
  CONCLUSIONS
  In all-comer DM patients the use of EES was associated with improved outcomes compared with SES and PES mainly driven by lower rates of ST and mortality. These results suggest better safety rather than efficacy with EES when compared with SES or PES.
authors.affiliation: Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands. kedhie@maasstadziekenhuis.nl
authors.forename: Elvin
authors.initials: E
authors.lastname: Kedhi
authors.forename: Marc E
authors.initials: ME
authors.lastname: Gomes
authors.forename: Bo
authors.initials: B
authors.lastname: Lagerqvist
authors.forename: J Gustav
authors.initials: JG
authors.lastname: Smith
authors.forename: Elmir
authors.initials: E
authors.lastname: Omerovic
authors.forename: Stefan
authors.initials: S
authors.lastname: James
authors.forename: Jan
authors.initials: J
authors.lastname: Harnek
authors.forename: Göran K
authors.initials: GK
authors.lastname: Olivecrona
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000601:surgery*; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D017239:Paclitaxel / Q000008:administration & dosage*; D062645:Percutaneous Coronary Intervention; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D013548:Sweden
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D017239:Paclitaxel; D020123:Sirolimus