Abstract 4346: One-year Outcomes After Implantation of Everolimus-eluting for Diabetic Patients With de-Novo Coronary Artery Stenoses: Insights From RESEARCH, T-SEARCH and X-SEARCH Registries
Objective: Everolimus-eluting stents (EES) have been shown to be more effective than Paclicaxel-eluting stent (PES) in the context of randomized trials with selected patients. However, the comparative safety and efficacy of the EES stent vs. Sirolimus-eluting stent (SES), PES and Bare-metal stent (BMS) in diabetics has not been fully investigated in an all-comer population.
Methods: One-hundred thirty consecutive diabetic patients treated exclusively with EES were enrolled. These patients were compared with 885 consecutive diabetic patients treated either with BMS (n=295), SES (n=139) or PES (n=451) in the RESEARCH and T-SEARCH registries in 2000 –2005. Major cardiac adverse events (MACE) were defined as the composite of all-cause mortality, any myocardial infarction (MI), or target vessel revascularization (TVR).
Results: The composite endpoint of all-cause mortality or MI was comparable among the four groups: 12.5% in the EES group vs. 13.2%, 12.4% and 12.3% in the BMS, SES and PES groups, respectively. The one-year TVR rate was significantly lower in the EES group than in the BMS group (7.8% vs. 15.2%, p=0.045), but comparable with the SES (vs. 11.8%, p=0.26) and PES group (vs. 8.6%, p=0.81). The MACE rate was 18.0%, 23.7%, 20.0%, 18.1% in the EES, BMS, SES and PES groups, respectively. After multivariable adjustment, the risk of MACE in the BMS group was significantly higher than in the EES group (adjusted HR 1.82 [95CI: 1.08 –3.07], p=0.03), but the SES and PES group demonstrated comparable risks of MACE with EES (adjusted HR SES vs. EES 1.31 [0.75–2.29] p=0.34, HR PES vs. EES 1.21 [0.73–1.98], p=0.46).
Conclusions: In an all-comer diabetic population, there were no differences in safety amongst Bare-metal and drug-eluting stents. At one year, EES was more effective than BMS, and as effective as SES and PES.