title: Everolimus-eluting versus sirolimus-eluting coronary stents in patients with and without diabetes mellitus.
abstract: OBJECTIVE
  Patients with diabetes mellitus have a higher risk of adverse events after percutaneous coronary intervention (PCI). This study aimed to elucidate the relative efficacy of everolimus-eluting stents (EES) versus sirolimus-eluting stents (SES) according to diabetic status.
  
  
  RESULTS
  Data from the EXCELLENT randomised trial and registry were pooled in a per protocol analysis manner. The primary endpoint was target lesion failure (TLF), a composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularisation. Among a total of 6,524 patients, 2,404 (36.8%) had diabetes mellitus. Patients with diabetes were shown to have a higher rate of TLF after PCI, which was mainly driven by differences in cardiac death and myocardial infarction, while the rate of repeat revascularisation and stent thrombosis did not differ significantly. TLF occurred at a similar rate between patients treated with EES versus SES in each subgroup stratified by diabetic status (interaction p=0.384). In addition, no significant interactions were present with regard to any pre-specified clinical endpoints. The results were corroborated by analysis with inverse probability of treatment weighting (interaction p=0.329). We also found that insulin-dependent diabetes imposed an even greater risk of TLF on patients treated with PCI.
  
  
  CONCLUSIONS
  Despite the recent advances in drug-eluting stent technology, diabetic patients are still at higher risk of adverse clinical events after PCI than those without diabetes mellitus. Whether a patient was treated with EES or SES had no significant interaction with diabetic status in terms of clinical outcome after PCI.
authors.affiliation: Cardiovascular Centre, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Si-Hyuck
authors.initials: SH
authors.lastname: Kang
authors.forename: Keun Ho
authors.initials: KH
authors.lastname: Park
authors.forename: Hyo-Suk
authors.initials: HS
authors.lastname: Ahn
authors.forename: Kyung Woo
authors.initials: KW
authors.lastname: Park
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Hong
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D023903:Coronary Restenosis; D023921:Coronary Stenosis / Q000150:complications / Q000628:therapy*; D048909:Diabetes Complications; D003920:Diabetes Mellitus; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus