Author + information
- Si–Hyuck Kang,
- Keun–Ho Park,
- Hyo–Suk Ahn,
- Kyung Woo Park,
- Young Joon Hong,
- Bon Kwon Koo,
- Myung Ho Jeong and
- Hyo–Soo Kim
Patients with diabetes mellitus have higher risk of adverse events after percutaneous coronary intervention (PCI). This study aimed to elucidate the relative efficacy of everolimus–eluting (EES) versus sirolimus–eluting stents (SES) according to diabetic status.
Data from the EXCELLENT randomized trial and registry were pooled in a manner of per–protocol analysis. Relative risks were derived from the crude analysis and adjusted for inverse probability of treatment weighting. The primary endpoint was target lesion failure (TLF), a composite of cardiac death, target vessel–related myocardial infarction, or target vessel revascularization.
A total of 6,524 study patients, 2,404 (36.8%) with and 4,120 (63.2%) without diabetes, were analyzed. Patients with diabetes mellitus had a higher rate of TLF after PCI, which was largely driven from differences in cardiac death and myocardial infarction, while the rate of repeat revascularization and stent thrombosis did not differ significantly. TLF occurred in a similar rate between patient treated with EES versus SES in each subgroup stratified by diabetic status (interaction P=0.384). In addition, no significant interactions were present with regard to any prespecified clinical endpoints. The results were corroborated by analysis with inverse probability of treatment weighting (interaction P=0.329). We also found that insulin–requiring diabetes imposed even greater risk of TLF on patients treated with PCI. Independent predictors for TLF were shown to be increasing age, congestive heart failure, chronic renal failure, and clinical diagnosis of acute myocardial infarction, as well as diabetes with a gradient according to its severity.
Despite the recent advances in drug–eluting stent technology, diabetic patients were still at higher risk of adverse clinical events after PCI than those without diabetes mellitus. Whether a patient was treated with EES or SES had no significant interaction with diabetic status in terms of clinical outcomes after PCI.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.–10:45 a.m.
Session Title: Coronary Stents
Abstract Category: 47. TCT@ACC–i2: Coronary Intervention, Devices
Presentation Number: 2101–236
- 2013 American College of Cardiology Foundation