Comparison of First- and Second-Generation Drug-Eluting Stents in an All-Comer Population of Patients with Diabetes Mellitus (from Katowice-Zabrze Registry).
BACKGROUND
This study compared safety and efficacy of first- and second-generation DES in an unrestricted, real-life population of diabetic patients undergoing PCI.


METHODS
The study was a subanalysis of diabetic patients from the all-comer Katowice-Zabrze Registry of patients undergoing PCI with the implantation of either first- (Paclitaxel-, Sirolimus-eluting stents) or second-generation DES (Zotarolimus-, Everolimus-, Biolimus-eluting stents). Efficacy defined as major adverse cardiac and cerebrovascular events (MACCE: death, myocardial infarction, target vessel revascularization, stroke) and safety defined as stent thrombosis (ST) were evaluated at 1 year.


RESULTS
From the total of 1916 patients, 717 were diabetics. Among them, 257 (36%) were treated with first-generation DES (230 [89%] Paclitaxel-eluting stents, 27 [11%] Sirolimus-eluting stents), 460 with second-generation DES (171 [37%] Zotarolimus-eluting stents, 243 [53%] Everolimus-eluting stents, 46 [10%] Biolimus-eluting stents). Rate of MACCE was equal in both groups (p=0.54). Second-generation DES had a better safety profile than first-generation DES (log-rank for cumulative ST at 1 year p<0.001). First-generation DES was a risk factor for ST (HR 5.75 [1.16-28.47], p=0.03) but not for MACCE (HR 0.89 [0.6-1.32], p=0.57).


CONCLUSIONS
In a real-life setting of diabetic patients undergoing PCI, second-generation DES had lower risk of ST and similar MACCE rate compared to first-generation DES.
2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland.
Damian
D
Kawecki
2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland.
Beata
B
Morawiec
2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland.
Janusz
J
Dola
3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Wojciech
W
Wańha
3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Grzegorz
G
Smolka
3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Aleksandra
A
Pluta
3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Kamil
K
Marcinkiewicz
3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Andrzej
A
Ochała
2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland.
Ewa
E
Nowalany-Kozielska
3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Wojciech
W
Wojakowski
D000368:Aged; D000792:Angiography; D023921:Coronary Stenosis / Q000188:drug therapy*; D003920:Diabetes Mellitus; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced; D009204:Myocardial Revascularization; D017239:Paclitaxel / Q000008:administration & dosage; D062645:Percutaneous Coronary Intervention; D011044:Poland; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D015607:Stents; D013927:Thrombosis; D016896:Treatment Outcome
D000068338:Everolimus; C489443:zotarolimus; D017239:Paclitaxel; C518022:umirolimus; D020123:Sirolimus