Author + information
- Received June 14, 2012
- Accepted June 21, 2012
- Published online November 1, 2012.
- Elvin Kedhi, MD, PhD⁎,⁎ (, )
- Marc E. Gomes, MD, PhD⁎,†,
- Bo Lagerqvist, MD, PhD‡,
- J. Gustav Smith, MD, PhD§,
- Elmir Omerovic, MD, PhD‖,
- Stefan James, MD, PhD‡,
- Jan Harnek, MD, PhD§ and
- Göran K. Olivecrona, MD, PhD§
- ↵⁎Reprint requests and correspondence
: Dr. Elvin Kedhi, Department of Cardiology, Maasstadziekenhuis, Maasstad Cardiovascular Research, Maasstadweg 21, 3079 DZ Rotterdam, the Netherlands
Objectives This study sought to study the second-generation everolimus-eluting stent (EES) as compared with first-generation sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) in diabetes mellitus (DM) patients.
Background There are limited data available comparing clinical outcomes in this setting with EES and SES, whereas studies comparing EES with PES are not powered for low-frequency endpoints.
Methods All DM patients treated with EES, PES, or SES from January 18, 2007, to July 29, 2011, from the SCAAR (Swedish Coronary Angiography and Angioplasty Registery) were included. The EES was compared with SES or PES for the primary composite endpoint of clinically driven detected restenosis, definite stent thrombosis (ST), and all-cause mortality.
Results In 4,751 percutaneous coronary intervention-treated DM patients, 8,134 stents were implanted (EES = 3,928, PES = 2,836, SES = 1,370). The EES was associated with significantly lower event rates compared with SES (SES vs. EES hazard ratio [HR]: 1.99; 95% confidence interval (CI): 1.19 to 3.08). The same was observed when compared with PES (PES vs. EES HR: 1.33; 95% CI: 0.93 to 1.91) but did not reach statistical significance. These results were mainly driven by lower incidence of ST (SES vs. EES HR: 2.87; 95% CI: 1.08 to 7.61; PES vs. EES HR: 1.74, 95% CI: 0.82 to 3.71) and mortality (SES vs. EES HR: 2.02; 95% CI: 1.03 to 3.98; PES vs. EES HR: 1.69; 95% CI: 1.06 to 2.72). No significant differences in restenosis rates were observed between EES and SES or PES (SES vs. EES HR: 1.26; 95% CI: 0.77 to 2.08; PES vs. EES HR: 1.05; 95% CI: 0.71 to 1.55).
Conclusions In all-comer DM patients the use of EES was associated with improved outcomes compared with SES and PES mainly driven by lower rates of ST and mortality. These results suggest better safety rather than efficacy with EES when compared with SES or PES.
- all-cause mortality
- condensed abstract
- diabetes mellitus
- everolimus-eluting stent
- paclitaxel-eluting stent
- sirolimus-eluting stent
- stent thrombosis
Dr. Kedhi has received lecture fees from Abbott Vascular, St. Jude Medical, and Terumo, Europe. Dr. Omerovic has received institutional research grants from Medtronic, Inc., AstraZeneca, and St. Jude; and has served on the advisory board and received honoraria from AstraZeneca. Dr. James has received institutional research grants from Medtronic, Inc., Vascular Solutions, Terumo, Inc., AstraZeneca, and Eli Lilly; and has served on the advisory board and received honoraria from AstraZeneca, Eli Lilly, Abbott Vascular, Boston Scientific, and Medtronic. Dr. Harnek has received institutional research grants from Medtronic, Inc., and Boston Scientific; and has served on the advisory board and received honoraria from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Kedhi and Gomes contributed equally to this work.
- Received June 14, 2012.
- Accepted June 21, 2012.
- American College of Cardiology Foundation