Abstract
BackgroundTo improve outcomes in patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention remain an unmet clinical need. The study aimed to evaluate the efficacy and safety of G2-DESs and BP-DESs in patients with and without DM in a single center in China.MethodsA total of 7666 consecutive patients who exclusively had G2-DES or BP-DES implantation throughout 2013 in our center were studied. The primary efficacy endpoint was any target lesion revascularization (TLR), whereas the primary safety endpoint was a composite of death or myocardial infarction (MI) at 2-year follow-up.ResultsG2-DESs had a similar occurrence of death, non-fatal MI, TLR, stroke, and stent thrombosis compared with BP-DESs in patients with DM (all P > 0.05). The incidence of TVR and TLR was lower for G2-DESs than for BP-DESs in patients without DM (3.2% vs. 5.1%, P = 0.002; 2.2% vs. 4.5%, P < 0.001, respectively). Kaplan–Meier analysis also showed better TVR- and TLR-free survival rates for G2-DESs than for BP-DESs in patients without DM. Multivariate analysis showed that a BP-DES was an independent risk factor for TLR (hazard ratio 1.963, 95% confidence interval 1.390–2.772, P < 0.001) in patients without DM, which was not predictive of other components of major adverse cardiac events (P > 0.05).ConclusionsG2-DESs have better efficacy, represented by a reduced risk of TLR, and similar safety compared with BP-DESs in patients without DM. G2-DESs have similar efficacy and safety compared with BP-DESs in patients with DM at 2-year follow-up.
Highlights
To improve outcomes in patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention remain an unmet clinical need
Second-generation DESs (G2-DESs), such as everolimus- and zotarolimus-eluting stents, markedly decrease the risk of early stent thrombosis and repeat revascularization compared with firstgeneration DESs and bare metal stents (BMS) [3,4,5,6]
After multivariable analysis with adjustment for age, sex, body mass index, left ventricular ejection fraction, serum creatinine levels, use of a proton pump inhibitor and GPIIa/IIIb, SYNTEX score, a history of coronary heart disease, previous percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), old myocardial infarction (OMI), hypertension, current smoker, multivessel disease, B2 or C lesions, the number of target lesions, the transradial approach, and chronic total occlusion lesions (CTO), use of a biodegradable polymer drug eluting stents (BP-DES) was still not an independent predictor of target lesion revascularization (TLR) in patients with DM (HR 1.453, 95% CI 0.891–2.371, P = 0.134) (Table 4)
Summary
To improve outcomes in patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention remain an unmet clinical need. Second-generation DESs (G2-DESs), such as everolimus- and zotarolimus-eluting stents, markedly decrease the risk of early stent thrombosis and repeat revascularization compared with firstgeneration DESs and BMSs [3,4,5,6] These new stents still have limitations, not least the requirement for prolonged dual-antiplatelet therapy and an apparent increase in the incidence of Academic Research Consortium definite early and late stent thrombosis [7]. DESs using biodegradable polymers were designed to overcome long-term adverse vascular reactions when drug elution is complete These stents may reduce the risk of in-stent restenosis and be non-inferior to in-segment late loss after deployment [10,11,12,13]
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