title: Comparison of clinical outcomes between first-generation and second-generation drug-eluting stents in type 2 diabetic patients.
abstract: BACKGROUND
  Drug-eluting stent (DES) implantation has significantly reduced the risk of restenosis and major adverse cardiac event (MACE) rates compared with bare-metal stents in type 2 diabetic patients. Differences in outcomes between the first-generation and second-generation DESs in diabetic patients, however, have yet to be evaluated.
  
  
  OBJECTIVE
  We compared MACEs after second-generation DES implantation compared with those of first-generation stents in diabetic patients.
  
  
  RESULTS
  This single-center prospective cohort study compared first-generation DES (n=654) and second-generation DES (n=339) implantation in type 2 diabetic patients by propensity score matching. The primary outcome was the occurrence of MACEs, defined as a composite of all-cause death, nonfatal myocardial infarction, and target vessel revascularization. The rate of MACEs was lower in the second-generation DES group after 2 years of follow-up (3.3 vs. 10.0%, P<0.001). Kaplan-Meier analysis showed higher MACE-free survival in diabetic patients in the second-generation DES group (log-rank P<0.001). In a Cox regression analysis, first-generation DES (hazard ratio=3.60, 95% confidence interval, 2.03-6.37, P<0.001) was an independent predictor for MACEs.
  
  
  CONCLUSIONS
  In type 2 diabetic patients, second-generation DES implantation resulted in lower MACEs compared with first-generation DESs, primarily because of lower target lesion and vessel revascularization rates.
authors.affiliation: aDepartment of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul bDepartment of Cardiology, Sejong General Hospital, Bucheon, Korea.
authors.forename: Han Saem
authors.initials: HS
authors.lastname: Jeong
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Cho
authors.forename: Eun Ji
authors.initials: EJ
authors.lastname: Kim
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Yu
authors.forename: Chul-Min
authors.initials: CM
authors.lastname: Ahn
authors.forename: Jae Hyoung
authors.initials: JH
authors.lastname: Park
authors.forename: Soon Jun
authors.initials: SJ
authors.lastname: Hong
authors.forename: Do-Sun
authors.initials: DS
authors.lastname: Lim
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D056910:Republic of Korea; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome