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Second-generation stent reduced thrombosis, all-cause mortality in diabetics
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The second-generation everolimus-eluting stent was associated with lower rates of stent thrombosis and all-cause mortality in patients with diabetes compared with first-generation sirolimus-eluting and paclitaxel-eluting stents, according to findings in a registry study.
For the study, researchers reviewed all patients with diabetes from the Swedish Coronary Angiography and Angioplasty Registry who were treated with the everolimus-eluting (EES), sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) from 2007 to July 2011.
In all, 4,751 patients were implanted with 8,134 stents (EES=3,928; PES=2,836; SES=1,370). The EES was associated with significantly lower event rates compared with SES (HR=1.99; 95% CI, 1.19-3.08). Lower rates of stent thrombosis were the main drivers of reduced incidence (SES vs. EES: HR=2.87; 95% CI, 1.08-7.61; PES vs. EES: HR=1.74; 95% CI, 0.82-3.71). EES was associated with lower event rates compared with PES (HR=1.33; 95% CI, 0.93-1.91), but this difference did not reach statistical significance.
Lower mortality rates were also observed (SES vs. EES: HR=2.02; 95% CI, 1.03-3.98; PES vs. EES: HR=1.69; 95% CI, 1.06-2.72); however, restenosis rates did not differ significantly (SES vs. EES: HR=1.26; 95% CI, 0.77-2.08; PES vs. EES: HR=1.05; 95% CI, 0.71-1.55).
The reduced incidence of stent thrombosis in the first year was particularly important to note, researchers wrote.
“Interestingly, significant lower rates of definite stent thrombosis with EES as compared to PES were observed also in the insulin-treated [diabetes mellitus] patients, while an opposite trend was observed in non-insulin-treated [diabetes mellitus] patients,” they wrote. “Although such findings can be due to chance, it is also known that insulin-treated [diabetes mellitus] represents the most severe form of this condition, which often has a longer duration and therefore can be expected to be associated with a more severe form of coronary disease. This could be the reason why the rates of stent thrombosis with PES in the insulin-treated [diabetes mellitus] patients … were higher, as similarly observed in other high-risk populations.”
Disclosure: Kedhi has received lecture fees from Abbott Vascular, St. Jude Medical and Terumo, Europe.
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