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A randomized study to compare bioactive titanium stents and everolimus-eluting stents in diabetic patients (TITANIC
José R López-Mínguez1, Juan M Nogales-Asensio1, Luis J Doncel-Vecino1
1Servicio de Cardiología, Hospital Universitario Infanta Cristina, Badajoz, Spain.
Introduction And Objectives:
Up to 25% of patients who undergo a percutaneous coronary intervention show some limitation in the use of drug-eluting stents. The aim of this study was to evaluate if titanium-nitride-oxide-coated stents could be a good alternative to everolimus-eluting stents in diabetic patients.
Methods:
A total of 173 diabetic patients with lesions at moderate risk of restenosis (exclusion criteria: diameter < 2.5 mm or length > 28 mm in vessels < 3mm, chronic occlusion) were randomized to a titanium group (83 patients) or an everolimus group (90 patients).
Results:
Baseline characteristics were well balanced; 28.3% of patients were insulin dependent. At 1 year, the incidence of major adverse cardiac events (death, nonfatal myocardial infarction, stroke, or repeat target vessel revascularization) was significantly higher in the titanium group than in the everolimus group (total, 14.5% vs 4.4%; P = .02; noninsulin-dependent subgroup, 9.7% vs 3.2%; P = .14; insulin-dependent subgroup, 28.6% vs 7.1%; P = .04). The incidence of death, nonfatal myocardial infarction, stroke, or any revascularization was 16.9% in the titanium group and 7.8% in the everolimus group (P = .06). Target lesion and vessel revascularizations occurred in 8.4% compared with 3.3% (P = .15) and in 13.3% compared with 3.3% (P = .01) in the titanium and everolimus groups, respectively. Angiographic follow-up at 9 months showed significantly less late lumen loss in the everolimus group (in-segment, 0.52 [standard deviation, 0.58) mm vs -0.05 [0.32] mm; in-stent, 0.76 [0.54] mm vs 0.13 [0.31] mm; P < .0001).
Conclusions:
The everolimus-eluting stent is superior to the titanium stent for clinical and angiographic end points in diabetic patients with lesions at moderate risk of restenosis.
Insights
Everolimus-eluting stents demonstrated superior clinical and angiographic outcomes compared to titanium-nitride-oxide-coated stents in diabetic patients. This finding is crucial for optimizing treatment strategies in this high-risk population.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomaterials Science
Background:
- Percutaneous coronary intervention (PCI) limitations exist with drug-eluting stents in up to 25% of patients.
- Diabetic patients represent a challenging subgroup for PCI due to higher restenosis rates.
Purpose of the Study:
- To compare the efficacy and safety of titanium-nitride-oxide-coated stents versus everolimus-eluting stents in diabetic patients undergoing PCI.
- To evaluate stent performance in diabetic patients with lesions at moderate risk of restenosis.
Main Methods:
- A randomized trial involving 173 diabetic patients with moderate restenosis risk.
- Patients were assigned to either a titanium stent group (83 patients) or an everolimus stent group (90 patients).
Main Results:
- The titanium group experienced a significantly higher incidence of major adverse cardiac events (MACE) at 1 year (14.5% vs. 4.4%, P=.02).
- Everolimus-eluting stents showed significantly less late lumen loss angiographically (P < .0001).
- Higher rates of target vessel revascularization were observed in the titanium group (13.3% vs. 3.3%, P=.01).
Conclusions:
- Everolimus-eluting stents are superior to titanium-nitride-oxide-coated stents in diabetic patients for both clinical and angiographic outcomes.
- These findings suggest everolimus-eluting stents are a preferred option for diabetic patients at moderate risk of restenosis.
