Paclitaxel-Eluting Versus Sirolimus-Eluting Stents in Diabetes Mellitus A Report From the National Heart, Lung, and Blood Institute Dynamic Registry

2010 
Background —Diabetes is a powerful predictor of adverse events in patients undergoing percutaneous coronary intervention. Drug-eluting stents reduce restenosis rates compared with bare metal stents; however, controversy remains regarding which drug-eluting stents provides greater benefit in patients with diabetes. Accordingly, we compared the safety and efficacy of sirolimus-eluting stents (SES) with paclitaxel-eluting stents (PES) among diabetic patients in a contemporary registry. Methods and Results —Using the National Heart, Lung, and Blood Institute Dynamic Registry, we evaluated 2-year outcomes of diabetic patients undergoing percutaneous coronary interventions with SES ( n =677) and PES ( n =328). Clinical and demographic characteristics, including age, body mass index, insulin use, left ventricular function, and aspirin/clopidogrel use postprocedure, did not differ significantly between the groups except that PES-treated patients had a greater frequency of hypertension and hyperlipidemia. At the 2-year follow-up, no significant differences were observed between PES and SES with regard to safety or efficacy end points. PES- and SES-treated patients had similar rates of death (10.7% versus 8.2%, P =0.20), death and myocardial infarction (14.9% versus 13.6%, P =0.55), repeat revascularization (14.8% versus 17.8%, P =0.36), and stent thrombosis (1.3% versus 1.3%, P =0.95). After adjustment, no significant differences between the 2 stent types in any outcome were observed. Conclusions —MPES and SES are equally efficacious and have similar safety profiles in diabetic patients undergoing percutaneous coronary interventions in clinical practice.
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