Head-to-head DES trial shows differing outcomes for adults with diabetes
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Among adults with diabetes who underwent PCI, rates of target lesion failure were similar for two drug-eluting stents, though net adverse clinical events varied between arms and differed for people taking insulin, data show.
“The introduction of DES diminished adverse events in patients with diabetes to some extent,” Nicole D. van Hemert, MD, cardiologist at University Medical Center Utrecht, the Netherlands, and colleagues wrote in Catheterization and Cardiovascular Interventions. “However, higher rates of adverse events following PCI are still reported specifically regarding revascularization. An ongoing effort is made to further reduce events in this population with often diffuse disease.”
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In a subanalysis of the prospective ReCre8 study, van Hemert and colleagues evaluated the 3-year clinical outcomes for 302 participants with diabetes after implantation of a permanent polymer zotarolimus-eluting stent (Resolute Integrity, Medtronic) or a polymer-free amphilimus-eluting stent (AES; Cre8, Alvimedica). The primary endpoint of the study was TLF, a composite of CV death, target vessel MI and target lesion revascularization.
After 3 years, TLF occurred in 12.5% of the ZES group compared with 10% of the AES group (P = .46). Components of the primary outcome were also comparable between the two study arms.
The secondary composite endpoint of net adverse clinical events was higher in the ZES arm (29.6%) vs. the AES arm (20%; P = .036).
Among participants with diabetes who were prescribed insulin therapy, TLF occurred in 19.1% of the ZES group vs. 10.4% of the AES group (P = .21). Net adverse clinical events occurred in 40.4% of the ZES group vs. 27.1% of the AES group (P = .1).
“Diabetic patients may benefit from implantation of the AES,” the researchers wrote. “A benefit regarding net adverse clinical events is established in the first year of follow‐up and is maintained throughout 3 years following PCI. Future dedicated trials should confirm these findings. Persistent increased rates of adverse events following PCI in patients with diabetes offer ongoing opportunities to improve care in this complex population.”
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