Abstract 4152: Comparison of Zotarolimus-Eluting Stent With Sirolimus-Eluting and Paclitaxel-Eluting Stent for Patients With Diabetes in the ZEST Trial: A Subanalysis of a Randomized Trial
BACKGROUND Studies comparing the first-generation sirolimus- and paclitaxel-eluting stents and the next-generation drug-eluting stents in the high-risk subgroup of patients with diabetes mellitus have been limited.
METHODS The “all-comers” design, ZEST trial was designed to compare the second-generation zotarolimus-eluting stent with the first-generation sirolimus-and paclitaxel-eluting stent for coronary revascularization in everyday clinical practice, and 2645 patients were enrolled. Randomization was stratified by the status of diabetes. The primary end point was a composite of major adverse cardiac events (death, myocardial infarction [MI], and ischemia-driven target-vessel revascularization [TVR]) at 12 months.
RESULTS A total of 760 diabetic patients (1080 lesions) received a zotarolimus (268 patients, 365 lesions), sirolimus (247 patients, 360 lesions), or paclitaxel (245 patients, 355 lesions)-eluting stent. Baseline clinical and angiographic characteristics were similar in the three groups. At 12 months, the zotarolimus-stent group showed similar rates of major adverse cardiac events compared with the paclitaxel-stent group (12.3% vs. 14.3%, P=0.51), but higher rates of events compared with the sirolimus-stent group (12.3% vs. 6.9%, P=0.04). The incidence of death or MI was similar among the groups (zotarolimus- vs. sirolimus- vs. paclitaxel-stent, 7.5% vs. 6.2% vs. 8.2%, respectively, P=0.77), but the rate of TVR significantly differ (zotarolimus- vs. sirolimus- vs. paclitaxel-stent, 6.3% vs. 0.8% vs. 7.3%, respectively, P=0.001). A nonsignificant trend was detected in favor of the sirolimus-stent group in the rate of stent thrombosis (zotarolimus- vs. sirolimus- vs. paclitaxel-stent, 1.5% vs. 0% vs. 1.2%, respectively, P=0.19).
CONCLUSIONS In patients with diabetes mellitus and coronary artery disease, the use of zotarolimus-eluting stents results in similar rates of major adverse cardiac events compared with paclitaxel-eluting stents, and in higher rates of major adverse cardiac events compared with sirolimus-eluting stents during 1 year of follow-up.