Abstract 12370: Everolimus-Eluting Xience V/Promus versus Zotarolimus-Eluting Resolute Stents in Diabetics
Background Diabetes Mellitus (DM) significantly increases the risk of adverse events after PCI. The efficacy and safety of second generation drug-eluting stent (DES) in diabetics have not been extensively evaluated. Therefore we compared everolimus-eluting stents (EES, Xience V/Promus) versus zotarolimus-eluting stent (ZES-R, Endeavor Resolute) regarding clinical outcomes in an “all-comer” group of patients with DM.
Methods and Results The subset of diabetics (1855 patients, 36.7%) from two prospective registries (EXCELLENT and RESOLUTE-KOREA registries) who were treated with EES (n=1855) or ZES-R (n=706) were compared. The rates of patient-related outcome (all-cause mortality, any MI, and any revascularization) in both stent groups were significantly higher in diabetics versus non-diabetics (EES, 10.7% vs. 7.9%, p=0.005; ZES-R, 13.2% vs. 7.6%, p=0.001). Despite a greater proportion of high risk patients in the ZES-R group, the rates of the stent-related outcome (target lesion failure, 3.7% vs. 3.5%, p=0.899) and the patient-related outcome (9.1% vs. 10.2%, p=0.416) were similar between EES and ZES-R group at 1 year, which was corroborated by similar results from the propensity score-matched cohort. On landmark analysis at 6 months, those on single antiplatelet therapy (SAT, n=251) after 6 months had significantly increased risk of target lesion failure (7.6% vs. 2.9%, p=0.001) compared with those continuing on dual antiplatelet therapy (DAT, n=1342), which was mainly driven by an increased risk of both cardiac death (4.9% vs. 0.1%, p>0.001) and target vessel-related MI (1.4% vs. 0.2%, p=0.049). SAT after 6 months was the most powerful predictor of target lesion failure in diabetics (HR 4.46, 95% CI 2.22-8.95, p>0.001).
Conclusion After unrestricted use of second generation DES in all-comers receiving PCI, diabetics had significantly worse clinical outcomes compared with non-diabetics. Within second generation DES, EES and ZES-R showed similar outcomes in diabetics up to 1 year follow-up. Nonetheless, even with the use of second generation DES, shorter duration of DAT resulted in significantly worse outcome compared with prolonged duration of DAT. Our data supports longer term DAT even with the use of second generation DES in diabetics.
- © 2012 by American Heart Association, Inc.