Abstract 4753: Paclitaxel- versus Sirolimus-Eluting Stents for Treatment of ST-segment Elevation Myocardial Infarction: Impact of Diabetes Mellitus
Background: Recent studies have shown the benefit of drug-eluting stents(DES) in patients with ST-segment elevation myocardial infarction(STEMI). Diabetes mellitus may differentially affect outcomes of DES. We compared clinical outcomes of paclitaxel-eluting(PES) versus sirolimus-eluting stent(SES) in diabetic patients with STEMI and evaluated the differential impact of diabetes on the performance of each stents.
Methods: We analyzed the large-scale, prospective, observational Korea Acute Myocardial Infarction Registry(KAMIR), that enrolled 3,894 patients (mean age, 62±12; 75% male; 26% with diabetes) with STEMI treated with PES or SES in 49 Korean hospitals, from November 2005 to January 2008.
Results: In diabetic patients with STEMI, PES didn’t differ from SES for major adverse cardiac event within 1 year (15.2% vs 14.0%, respectively; hazard ratio[HR](95% CI), 1.12(0.79–1.59); p=0.534). In non-diabetic population, however, more major adverse cardiac events occurred with PES than with SES (11.6% vs 8.2%; HR(95% CI), 1.35(1.04–1.72); p=0.021), being attributed to increased target vessel revascularization (5.3% vs 2.4%; HR(95% CI), 2.33(1.43–3.70); p=0.001). For target vessel revascularization, there was interaction between the type of stents and diabetes mellitus (for unadjusted: p=0.050; for propensity-score risk adjustment: p=0.032; for propensity-score matching: p=0.074).
Conclusion: In this large-scale registry, PES was not inferior to SES for the treatment of STEMI with diabetes mellitus during 1 year follow-up. And diabetes mellitus showed differential effect on the target vessel revascularization rates of two DES groups.