title: Clinical impact of second-generation everolimus-eluting stents compared with first-generation drug-eluting stents in diabetic patients undergoing multivessel percutaneous coronary intervention.
abstract: OBJECTIVE
  This study aimed to evaluate the safety and efficacy of everolimus-eluting stent (EES) use compared with first-generation drug-eluting stent (DES) use in diabetic patients undergoing multivessel percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Although the benefits of EES over first-generation DES were demonstrated for the general population, there is a paucity of data in diabetic patients with multivessel disease.
  
  
  METHODS
  The retrospective study cohort included 429 consecutive diabetic patients who underwent native multivessel PCI, defined as ≥2 same-generation DESs in ≥2 different native vessel territories during the index procedure. The primary safety endpoint was the combined incidence of death, non-fatal Q-wave myocardial infarction, and definite stent thrombosis (ST) at 1 year.
  
  
  RESULTS
  At 1 year, the primary safety endpoint was reached in 2.9% of the patients in the EES group, which was significantly lower than the 9.3% noted with first-generation DES (P=.03). The occurrence of definite or probable ST was lower in the EES group (0% vs. 3.7%; P=.04). Similarly, there was a trend toward lower all-cause mortality (2.9% vs. 8.5%; P=.05) and cardiac death (1% vs. 4.9%; P=.08) in the EES group. However, there were no significant differences in the rates of target lesion revascularization (12.6% vs. 9.3%; P=.33) between groups. In a multivariate model, EES was independently associated with a lower risk of composite primary endpoint compared with first-generation DES (hazard ratio, 0.28; 95% confidence interval, 0.09-0.94).
  
  
  CONCLUSIONS
  In diabetic patients undergoing native multivessel PCI, the use of EES was associated with superior 1-year safety as compared with use of first-generation DES.
authors.affiliation: MedStar Washington Hospital Center, Division of Cardiology, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010. ron.waksman@medstar.net.
authors.forename: Lakshmana
authors.initials: L
authors.lastname: Pendyala
authors.forename: Joshua
authors.initials: J
authors.lastname: Loh
authors.forename: Hironori
authors.initials: H
authors.lastname: Kitabata
authors.forename: Sa'ar
authors.initials: S
authors.lastname: Minha
authors.forename: Fang
authors.initials: F
authors.lastname: Chen
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: William
authors.initials: W
authors.lastname: Suddath
authors.forename: Lowell
authors.initials: L
authors.lastname: Satler
authors.forename: Augusto
authors.initials: A
authors.lastname: Pichard
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000068338:Everolimus / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000068338:Everolimus