title: Long-term outcome of the unrestricted use of everolimus-eluting stents compared to sirolimus-eluting stents and paclitaxel-eluting stents in diabetic patients: the Bern-Rotterdam diabetes cohort study.
abstract: BACKGROUND
  Newer generation everolimus-eluting stents (EES) improve clinical outcome compared to early generation sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES). We investigated whether the advantage in safety and efficacy also holds among the high-risk population of diabetic patients during long-term follow-up.
  
  
  METHODS
  Between 2002 and 2009, a total of 1963 consecutive diabetic patients treated with the unrestricted use of EES (n=804), SES (n=612) and PES (n=547) were followed throughout three years for the occurrence of cardiac events at two academic institutions. The primary end point was the occurrence of definite stent thrombosis.
  
  
  RESULTS
  The primary outcome occurred in 1.0% of EES, 3.7% of SES and 3.8% of PES treated patients ([EES vs. SES] adjusted HR=0.58, 95% CI 0.39-0.88; [EES vs. PES] adjusted HR=0.29, 95% CI 0.13-0.67). Similarly, patients treated with EES had a lower risk of target-lesion revascularization (TLR) compared to patients treated with SES and PES ([EES vs. SES], 5.6% vs. 11.5%, adjusted HR=0.68, 95% CI: 0.55-0.83; [EES vs. PES], 5.6% vs. 11.3%, adjusted HR=0.51, 95% CI: 0.33-0.77). There were no differences in other safety end points, such as all-cause mortality, cardiac mortality, myocardial infarction (MI) and MACE.
  
  
  CONCLUSIONS
  In diabetic patients, the unrestricted use of EES appears to be associated with improved outcomes, specifically a significant decrease in the need for TLR and ST compared to early generation SES and PES throughout 3-year follow-up.
authors.affiliation: Thoraxcenter, Department of Cardiology, Erasmus Medical Center Rotterdam, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Simsek
authors.forename: L
authors.initials: L
authors.lastname: Räber
authors.forename: M
authors.initials: M
authors.lastname: Magro
authors.forename: E
authors.initials: E
authors.lastname: Boersma
authors.forename: Y
authors.initials: Y
authors.lastname: Onuma
authors.forename: G G
authors.initials: GG
authors.lastname: Stefanini
authors.forename: T
authors.initials: T
authors.lastname: Zanchin
authors.forename: B
authors.initials: B
authors.lastname: Kalesan
authors.forename: P
authors.initials: P
authors.lastname: Wenaweser
authors.forename: P
authors.initials: P
authors.lastname: Jüni
authors.forename: R J
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: R T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: S
authors.initials: S
authors.lastname: Windecker
authors.forename: P W J C
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology; D054855:Drug-Eluting Stents / Q000639:trends*; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017239:Paclitaxel / Q000008:administration & dosage*; D020123:Sirolimus / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000068338:Everolimus; D017239:Paclitaxel; D020123:Sirolimus
keywords: ARC; Academic Research Consortium; Adjusted Hazard Ratio; BMS; Bare-Metal Stents; CI; Confidence Interval; DES; DM; Diabetes Mellitus; Diabetes mellitus; Drug-Eluting Stents; ECG; EES; ElectroCardioGraphy; Everolimus-Eluting Stents; Everolimus-eluting stent; IQR; Inter Quartile Range; MACE; MI; Major Adverse Cardiac Events; Myocardial Infarction; PCI; PES; Paclitaxel-Eluting Stents; Paclitaxel-eluting stent; Percutaneous Coronary Intervention; Percutaneous coronary intervention; RESEARCH; Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital; SD; SES; ST; Sirolimus-Eluting Stents; Sirolimus-eluting stent; Standard Deviation; Stent Thrombosis; T-SEARCH; TLR; TVR; Target-Lesion Revascularization; Target-Vessel Revascularization; Taxus–Stent Evaluated At Rotterdam Cardiology Hospital; X-SEARCH; XIENCE-Stent Evaluated At Rotterdam Cardiology Hospital; aHR