Clinical impact of second-generation everolimus-eluting stents compared with first-generation drug-eluting stents in diabetic patients undergoing multivessel percutaneous coronary intervention

OBJECTIVES: 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). CONCLUSION: 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.