Original title: Safety and Efficacy of Everolimus-Eluting Stents Versus Paclitaxel-Eluting Stents in a Diabetic Population Reference: Ana Laynez et, al. Catheterization and Cardiovascular Intervention 81:759-765 (2013)
Everolimus eluting stents have already been compared with paclitaxel eluting stents in the general population, and they have proved to perform best, especially as regards revascularization and in-stent thrombosis.
However, these data were not as clear for the diabetic population subgroup. This study included 968 consecutive diabetic patients; 550 received Paclitaxel eluting stents (PES), TAXUS (Boston Scientific Corporation, Natick, MA) and 338 received Everolimus eluting stents (EES), Xience V (Abbott Vascular, Santa Ana, CA) or Promus (Boston Scientific Corporation, Natick, MA).
The type of stent was left to the operators criteria. Angiographic success was similar and high in both groups; the PES group presented more complex lesions that required more and longer stents, more use of glycoprotein IIbIIIa inhibitors and coronary intravascular ultrasound. In the raw analysis at 30 days, patients receiving PES presented a higher TLR- MACE (4.2% vs. 1.3% p=0.02) and TVR- MACE (4.3% vs. 1.8% p=0.02). At midterm follow up, patients that received PES presented more cardiac mortality both at 6 months (3.8% vs, 1% p=0.02) and a year (4.8% vs. 1% p=0.02).
After adjusting the different variables no significant difference was observed in terms of TLR-MACE in the two groups (HR: 1.05, 95% CI: 0.70–1.57, p= 0.80). 8 patients presented stent thrombosis; all of them had received PES (four, acute thrombosis, 3 subacute and one late thrombosis).
Conclusion:
In diabetic patients, the use of everolimus eluting stents vs. paclitaxel eluting stents is associated with a lower rate of stent thrombosis and a similar rate of the combination of death, infarction and revascularization after a year.
Comment:
Despite the limitation of being a retrospective study, from one center only, and that the choice of DES was left to the operator, this study adds some information about DES results in diabetics. Both the SPIRIT IV and the COMPARE included relatively few diabetic patients and this allowed some analysis of subgroups with non conclusive results; neither are this study’s results, though they do add information to the previous.
Courtesy of Dr. Carlos Fava.
Interventional Cardiology.
Favaloro Foundation. Argentina
Dr. Carlos Fava para SOLACI.ORG