Abstract 2808: The long-term efficacy of Sirolimus- and Paclitaxel-Eluting Stents as Compared to Bare Metal Stents in Patients with Diabetes Mellitus
Background Diabetics are known to have an accelerated and more aggressive form of atherosclerosis. Both paclitaxel- and sirolimus-eluting stents (PES and SES respectively) showed to reduce clinical and angiographic restenosis as compared to bare metal stents (BMS) up until 1 year. Due to the different mechanisms of action of both drugs and the interference with the PI3-kinase pathway, which is degraded in diabetic patients, it is currently unknown which device is the best option to treat these high-risk patients.
Methods The present study compares the 2-year outcome of a series of 708 consecutive diabetic patients (25% insulin treated) treated with either a BMS, a SES or a PES, as part of the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) and Taxus-Stent Evaluated at Rotterdam Cardiology Hospital (T-SEARCH) registries respectively.
Results All-cause mortality did not differ significantly between the 3 groups. As compared to BMS, the use of PES but not SES, was associated with significantly lower rates of both target lesion- and target vessel revascularization (TLR and TVR respectively). Stent thrombosis was more frequent in the SES group (3.9%) as compared to the BMS group (0%) and PES group (1.2%). When correcting for independent predicors of adverse events and differences between the groups, the use of PES was associated with significantly lower rates of both TLR and the composite endpoint of MACE (death, non-fatal myocardial infarction (MI) and TVR) as compared to SES.
Conclusions The use of PES was associated with a more favorable outcome in terms of major adverse cardiac events in a real world diabetic patient population as compared to SES and BMS.