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Comparison of three-year clinical outcomes between sirolimus-versus paclitaxel-eluting stents in diabetic patients:
Soon Jun Hong1, Moo Hyun Kim, Kwang Soo Cha
1Department of Cardiology, Korea University Anam Hospital, Seoul, Korea.
Insights
This study found no significant difference in major adverse cardiovascular events (MACE) or stent thrombosis between sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) over three years in diabetic patients. Insulin treatment independently predicted MACE and target vessel revascularization.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Diabetes Mellitus Management
Background:
- Limited data exists on the three-year outcomes of sirolimus-eluting stents (SES) versus paclitaxel-eluting stents (PES) in diabetic patients.
- Predictors of major adverse cardiovascular events (MACE) in this specific population remain under-reported.
Purpose of the Study:
- To compare the three-year incidence of MACE and stent thrombosis between SES and PES in diabetic patients.
- To identify predictors of MACE and target vessel revascularization (TVR) in this cohort.
Main Methods:
- A prospective, randomized trial involving 169 diabetic patients with de novo coronary lesions.
- Patients were assigned to receive either SES or PES.
- Outcomes were assessed over a three-year follow-up period.
Main Results:
- No significant differences in MACE rates (5.9% SES vs. 9.5% PES, P=0.374) or definite stent thrombosis (1.2% SES vs. 3.6% PES, P=0.368) were observed at three years.
- Multivariate analysis identified insulin treatment as the sole independent predictor for MACE (OR 8.60) and TVR (OR 9.50).
Conclusions:
- Sirolimus-eluting stents and paclitaxel-eluting stents demonstrate similar three-year safety and efficacy profiles in diabetic patients.
- Insulin therapy is a critical independent predictor of adverse cardiovascular events and TVR following coronary stent implantation in diabetic individuals.
Background:
Three-year follow-up of major adverse cardiovascular event (MACE) (death, nonfatal myocardial infarction, target lesion revascularization) and the predictors of MACEs in diabetic patients after sirolimus-eluting stent (SES) or paclitaxel-eluting stent (PES) implantation have not been reported.
Methods:
Diabetic patients with de novo coronary lesions (169 patients with 190 lesions) were randomly assigned prospectively to either SES or PES.
Results:
Baseline characteristics were similar between the two groups. The rates of MACEs [5.9% (n = 5) in the SES vs. 9.5% (n = 8) in the PES Group, P = 0.374] and definite stent thrombosis [1.2% (n = 1) in the SES vs. 3.6% (n = 3) in the PES Group, P = 0.368] were similar in the two groups during the three-year follow-up. Multivariate logistic analysis showed that insulin treatment was the only independent predictor of MACE [odds ratio (OR) 8.60, 95% confidence interval (CI) 3.25-22.76, P < 0.001] and target vessel revascularization (TVR) (OR 9.50, 95% CI 3.07-29.44, P < 0.001) during the three-year follow-up.
Conclusions:
The rates of MACEs, TVR, and stent thrombosis during the three-year follow-up were similar in the SES and PES Groups. Insulin treatment was a main predictor of MACEs and TVR during the three-year follow-up after either SES or PES implantation.