Safety and efficacy of everolimus-eluting stents versus paclitaxel-eluting stents in a diabetic population

Ana Laynez, Gabriel Sardi, Camille Hauville, Israel M. Barbash, Rajbabu Pakala, Rebecca Torguson, Zhenyi Xue, Lowell F. Satler, Augusto D. Pichard, Ron Waksman

Research output: Contribution to journalReview articlepeer-review

Abstract

Objectives: This study aimed to analyze the use of everolimus-eluting stents (EES) and paclitaxel-eluting stents (PES) in an unrestricted diabetic population and to compare the performance of these two drug-eluting stents. Background: EES have demonstrated superiority in efficacy when compared to PES in a general population. However, it is controversial whether this superiority holds true in a diabetic population. Methods: From March 2004 to May 2010, 968 patients with consecutive diabetes who underwent percutaneous coronary intervention and implantation of an EES (n 5 388) or PES (n 5 580) at our institution. In-hospital, 1-month, 6-month, and 1-year clinical outcomes were analyzed and compared. Correlates of major adverse cardiac events (MACE) were identified. Results: Baseline clinical characteristics were similar between stent types except for more family history of coronary artery disease in the PES group and more insulin-dependent diabetes and unstable angina at initial diagnosis in the EES group. The PES group had higher number of lesions treated, longer stents used, and a higher proportion of intravascular ultrasound and glycoprotein IIb/IIIa inhibitor use. The EES group had more type C and distal lesions. There was higher target lesion revascularization (TLR)-MACE in the PES group (3.3% vs. 1.0%, P = 0.03) as well as a higher rate of stent thrombosis (ST) (8 patients vs. 0 in the EES group, P = 0.03). ST continued to be higher in the PES group at 6 and 12 months and mortality was higher at 12 months in the PES group (9.4% vs. 5.2%, P = 0.02). After adjustment, no significant differences were found between stent types on Cox regression analysis for hazard ratios at 1-year follow-up of TLR-MACE. Conclusions: In a diabetic population undergoing PCI, the use of an EES compared to PES was associated with lower rates of stent thrombosis; but after adjustment the composite TLR-MACE at 1 year was similar between both stents.

Original languageEnglish
Pages (from-to)759-765
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume81
Issue number5
DOIs
StatePublished - Apr 2013
Externally publishedYes

Keywords

  • Diabetes
  • Everolimus-eluting stent
  • Paclitaxel-eluting stent

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