Drug-eluting Stents In Diabetic Patients Research Articles

PMD14 Budget Impact analysis of Two Drug-Eluting Stents for Diabetic Patients in Spain

PMD14 Budget Impact analysis of Two Drug-Eluting Stents for Diabetic Patients in Spain

Cost analysis of four major drug-eluting stents in diabetic populations

To use an indirect comparisons approach and conduct a cost analysis comparing four drug-eluting stents (DES) from a United States (US) payer (i.e., fixed-fee reimbursement) perspective. Studies were chosen that randomised two or more DES in diabetic patients. A one-year target lesion revascularisation (TLR) risk for Taxus was first derived. Risk Ratios (RRs) for each DES versus Taxus were calculated through meta-analyses. The RRs were multiplied by the average TLR risk for Taxus to estimate DES TLR risks. Estimates were added to a budget-impact model, along with utilisation and reimbursement rates for diagnosis-related groups. Budgets were calculated, assuming 100% stent use and 200,000 diabetic beneficiaries. One-year TLR risks were estimated to be 3.2%, 7.1%, 6.9% and 7.9% for Cypher, Endeavor, Taxus and Xience respectively. By substituting Cypher for DES with higher TLR, results predicted annual cost-savings greater than $146 million per population ($ 733 per patient). Results were comparable when assuming no difference in TLR risk between Endeavor, Taxus and Xience. When outcomes from trials of diabetic populations are analysed and used in a budget-impact model from a US payer perspective, the use of Cypher is associated with lower TLR rates, which translates into large potential cost savings.

Outcomes with drug-eluting stents in diabetic patients

The relationship between diabetes mellitus and coronary artery disease is well established. The percentage of patients participating in clinical trials of percutaneous coronary intervention who have diabetes is quickly rising. Diabetic patients have a worse prognosis than nondiabetic patients, with generally greater rates of death, myocardial infarction and need for target lesion and vessel revascularization. Stenting has improved the outcome of diabetic patients receiving percutaneous coronary intervention. Compared with bare-metal stents, the use of drug-eluting stents in diabetic patients has resulted in a significant reduction in late lumen loss, binary restenosis, and clinically driven target vessel revascularization. The safety and efficacy of drug-eluting stents in diabetic patients is now well established; they are the preferred option in this subgroup in the absence of contraindications. New stent designs, polymers and drugs are resulting in better outcomes overall, but more research is required ...

Novel Approaches for Preventing or Limiting Events in Diabetic Patients (Naples-Diabetes) Trial

Background— To expand the paucity of data on the efficacy of various drug-eluting stents in diabetic patients. Methods and Results— Type 2 diabetic patients treated in our institution from October 2005 to January 2007 presenting with of de novo lesions in native coronary arteries were randomly assigned to sirolimus-eluting stents (Cypher group; n=76); paclitaxel-eluting stents (Taxus group; n=75); and everolimus-eluting stents (Endeavor group; n=75). Poor metabolic control (HbA1c >7% and low-density lipoprotein cholesterol >100 mg/dL) and microvascular complications (retinopathy and/or nephropathy) were assessed. The primary end point was the 3-year composite of major adverse cardiac events (MACE), including death of any cause, myocardial infarction, and clinically driven target vessel revascularization. MACE-free survival was 86.8% in the Cypher group, 82.5% in the Taxus group, and 64.4% in the Endeavor group ( P =0.006 by log-rank test). The post hoc comparisons showed no significant difference between Cypher versus Taxus groups (adjusted P =1.0) but a higher MACE rate in the Endeavor group versus both the Cypher group (adjusted P =0.012) and the Taxus group (adjusted P =0.075). Independent predictors of 3-year MACE at Cox analysis were treatment by Endeavor versus Cypher stent (2.35 [95% confidence interval, 1.07 to 5.41]; P =0.030), multivessel disease (hazard ratio, 1.78 [95% confidence interval, 1.06 to 2.66]; P =0.031), diabetic retinopathy (hazard ratio, 1.60; [95% confidence interval, 1.03 to 2.76]; P =0.038), and poor metabolic control (hazard ratio, 1.60; [95% confidence interval, 1.02 to 2.52]; P =0.048). Conclusions— The present pilot study suggests that in diabetic patients, the Endeavor stent is associated with a higher 3-year MACE rate when compared with Cypher and Taxus stents.

Long-term outcome after sirolimus-eluting stents versus bare metal stents in patients with Diabetes mellitus: a patient-level meta-analysis of randomized trials

Although it is widely believed that patients with diabetes mellitus obtain the greatest benefit from drug-eluting stents, convincing evidence on long-term efficacy and safety of these stents is lacking. We performed a meta-analysis of individual patient data from four randomized trials including 583 patients comparing sirolimus eluting with bare metal stents (median follow-up of 4.2years). These were the only specific trials reporting on drug-eluting stents in diabetic patients. The primary endpoint was the incidence of major cardiac events. The secondary endpoints were all-cause mortality and myocardial infarction as a safety endpoint and target lesion re-intervention as an efficacy endpoint. Stent thrombosis was also evaluated. There was a significant reduction in the overall hazard of major cardiac events (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.36-0.63, P<0.001) with sirolimus-eluting stents. This was mostly due to a significant reduction in the overall hazard of repeat revascularization (HR 0.27, 95% CI 0.18-0.41, P<0.001) in favor of sirolimus-eluting stents. However, the overall hazard of death (HR 0.91, 95% CI 0.59-1.41, P=0.68) as well as death or myocardial infarction (HR 0.77, 95% CI 0.54-1.09, P=0.14) were not significantly different between the groups. No significant differences were observed regarding stent thrombosis (HR 0.50, 95% CI 0.15-1.69, P=0.26). Sirolimus-eluting stents are highly effective in reducing the risk for major cardiac events and safe in diabetic patients with coronary artery disease.

Comparison of Bypass Surgery with Drug-Eluting Stents in Diabetic Patients with Left Main Coronary Stenosis

PurposeSeveral studies have compared the effects of coronary stenting and coronary-artery bypass grafting (CABG) on left main coronary artery (LMCA) disease. However, there are limited data on the long-term outcomes of these two interventions in diabetic patients.Materials and MethodsWe evaluated 56 patients with LMCA stenosis who underwent drug-eluting stent (DES) implantation and 116 patients who underwent CABG in a single hospital in China between January 2004 and December 2006. We compared long-term major adverse cardiac events (death; a "serious outcome" composite of death, myocardial infarction, or stroke; and target-vessel revascularization).ResultsIn-hospital (30-day) mortality was 0% for the DES group and 3.4% for the CABG group (p=0.31). There was no difference between the two groups in terms of risk of death [hazard ratio for stenting group, 0.49; 95% confidence interval (CI), 0.13-1.63; p=0.55] or risk of serious outcome (hazard ratio for DES group, 1.11; 95% CI, 0.39-1.45; p=0.47). The target-vessel revascularization rate was higher in the DES group than in the CABG group (hazard ratio, 3.67; 95% CI, 1.24-11.06; p=0.018).ConclusionIn this cohort of diabetic patients with LMCA stenosis, there was no difference in composite endpoints between patients receiving DESs and those undergoing CABG. However, stenting was associated with higher rates of target-vessel revascularization than CABG. DES implantation in diabetic patients with LMCA disease was found to be at least as safe as CABG.

Outcomes in Diabetic and Nondiabetic Patients Treated With Everolimus- or Paclitaxel-Eluting Stents: Results From the SPIRIT IV Clinical Trial (Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System)

We compared the safety and efficacy of the XIENCE V (Abbott Vascular, Santa Clara, California) everolimus-eluting stent (EES) with the TAXUS Express (Boston Scientific, Natick, Massachusetts) paclitaxel-eluting stent (PES) among the large cohort of randomized diabetic patients enrolled in the SPIRIT IV (Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System) trial. Diabetes mellitus remains a significant predictor of adverse clinical outcomes after percutaneous coronary intervention with drug-eluting stents, and the comparative outcomes of different drug-eluting stents in diabetic patients remains ill-defined. In the SPIRIT IV trial, 3,687 patients with up to 3 de novo native coronary artery lesions were prospectively randomized 2:1 to receive EES or PES. Randomization was stratified by the presence of diabetes and lesion complexity. The primary end point was the occurrence of target lesion failure (TLF) (cardiac death, target-vessel myocardial infarction, or ischemia-driven target lesion revascularization) at 1 year. Clinical outcomes were evaluated in randomized diabetic (n = 1,185 [786 EES; 399 PES]) and nondiabetic patients (n = 2,498 [1,669 EES; 829 PES]). The EES compared with PES reduced TLF in nondiabetic patients (3.1% vs. 6.7%, p < 0.0001), with significant reductions in myocardial infarction, stent thrombosis, and target lesion revascularization. In contrast, no difference in TLF (6.4% vs. 6.9%, respectively, p = 0.80) or any of its components was present among diabetic patients, regardless of insulin use. A significant interaction between the presence of diabetes and stent type on TLF (p(interaction) = 0.02) was observed. In the SPIRIT IV randomized trial, EES compared with PES provided similar clinical outcomes in diabetic patients and superior clinical outcomes in nondiabetic patients at 1 year. (SPIRIT IV Clinical Trial: Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System in the Treatment of Subjects With de Novo Native Coronary Artery Lesions; NCT00307047).

TCT-114: Duration of Dual Antiplatelet Therapy after Implantation of Drug-Eluting Stents in Diabetic Patients: A Subgroup Analysis of the Randomized, Clinical Trial

TCT-114: Duration of Dual Antiplatelet Therapy after Implantation of Drug-Eluting Stents in Diabetic Patients: A Subgroup Analysis of the Randomized, Clinical Trial

TCT-312: Long-Term Clinical Outcomes of Drug-Eluting Stents in Diabetic Patients with Small Vessel Compared to Larger vessel - Up to 7 Years Clinical Follow-up

TCT-312: Long-Term Clinical Outcomes of Drug-Eluting Stents in Diabetic Patients with Small Vessel Compared to Larger vessel - Up to 7 Years Clinical Follow-up

Safety and efficacy of drug-eluting vs. bare metal stents in patients with diabetes mellitus: long-term follow-up in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)

Patients with diabetes mellitus have more extensive coronary artery disease, more disease progression, and restenosis. The use of drug-eluting stents (DES) in these patients is widespread, despite uncertain long-term safety and efficacy. All consecutive patients with diabetes mellitus in Sweden who underwent percutaneous coronary intervention were entered into the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) during 2003-06 with complete follow-up for 1-4 years (median 2.5). Patients who received at least one DES (n = 4754) were compared with those who received only bare metal stents (BMS) (n = 4956) at the index procedure. Combined outcome of death or myocardial infarction (MI) showed no difference for DES vs. BMS, relative risk (RR), 0.91 [95% confidence interval (CI), 0.77-1.06]. Myocardial infarction was significantly less common with DES in patients who received only one stent RR, 0.80 (95% CI, 0.66-0.96). The restenosis rate was 50% lower in DES-treated patients RR, 0.50 (95% CI, 0.35-0.70) and was associated with a higher adjusted RR of MI, RR, 5.03 (95% CI, 4.25-5.97). DES was associated with reduced restenosis rates in all subgroups of diabetic patients with the greatest benefit in stent diameters <3 mm or stent length >20 mm. The number of lesions treated with DES to prevent one restenosis ranged from 11 to 47 in various subgroups. This real-life registry study shows that restenosis was halved by DES in diabetic patients with stable or unstable coronary disease, with similar risk of death or MI up to 4 years compared with BMS.

Drug-Eluting Stents Versus Bare-Metal Stents in Diabetic Patients With ST-Segment Elevation Acute Myocardial Infarction: A Pooled Analysis of Individual Patient Data From 7 Randomized Trials

The performance of drug-eluting stents (DESs) in high-risk patients with diabetes and acute ST-elevation myocardial infarction (STEMI) who have undergone primary angioplasty has not been previously studied. The objective was to evaluate the efficacy and safety of DESs in diabetic patients with STEMI. We performed a pooled analysis of individual patient data from seven randomized trials that compared DESs (i.e., sirolimus- or paclitaxel-eluting stents) with bare-metal stents (BMSs) in patients with STEMI. The analysis involved 389 patients with diabetes mellitus from a total of 2476 patients. The outcomes of interest were target-lesion revascularization, stent thrombosis, death and the composite endpoint of death or recurrent myocardial infarction during a follow-up of 12-24 months. Overall, 206 diabetic patients received a DES and 183, a BMS. The risk of target-lesion revascularization was significantly lower in patients treated with a DES compared to those treated with a BMS (hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.23-0.88; P=.02). There was no significant difference in the risk of stent thrombosis between those treated with a DES or a BMS (HR 0.33, 95% CI 0.09-1.13; P=.08). Similarly, the risk of the combined endpoint of death or myocardial infarction was not significantly different between patients treated with a DES or a BMS (HR 0.64, 95% CI 0.36-1.13; P=.12). Compared with BMSs, DES use improved clinical outcomes in diabetic patients undergoing primary angioplasty for STEMI: the need for reintervention was reduced, with no increase in mortality or myocardial infarction.

Long‐term clinical benefit of drug‐eluting stents over bare‐metal stents in diabetic patients with de novo left main coronary artery disease: Results from a real‐world multicenter registry

Few data are available on diabetic patients undergoing percutaneous coronary intervention (PCI) in the context of unprotected left main coronary artery (ULMCA) disease. The main goal of this study was to present the long-term relative benefits of using drug-eluting stent (DES) instead of bare-metal stent (BMS) for diabetic patients submitted to percutaneous ULMCA treatment in a large real world multicenter registry. The GISE-SICI registry is a retrospective, observational multicenter registry promoted by the Italian Society of Invasive Cardiology in which 19 high-volume participating centers enrolled 1,453 consecutive patients who underwent PCI on ULMCA between January 2002 and December 2006. From the registry, a total of 398 consecutive patients with diabetes mellitus who underwent DES (n = 321) or BMS (n = 77) implantation were analyzed, with extensive multivariable adjustments. At 3-years, use of DES in diabetic patients resulted in no significant differences with respect to death (HR 0.56, 95% CIs 0.24-1.28), myocardial infarction (HR 0.82, 95% CIs 0.21-3.26), and the composite end-point of death or myocardial infarction (HR 0.56, 95% CIs 0.27-1.20). Conversely, DES were associated with significant reduction of target lesion revascularization (TLR, HR 0.33; 95% CIs 0.14-0.80, P = 0.001) rates. Patients presenting with ULMCA disease in the context of diabetes mellitus who are treated with stent-supported PCI have a significant reduction in the rate of TLR with no increased risk of death or myocardial infarction.

Impacto do diabetes melito na eficácia e na segurança dos stents farmacológicos: registro com até cinco anos de seguimento

INTRODUCAO: Diabeticos possuem risco aumentado para ocorrencia de eventos cardiovasculares. Estudos revelam que os stents farmacologicos reduzem a reestenose e a revascularizacao da lesao-alvo em pacientes diabeticos e nao-diabeticos. Entretanto, poucos estudos avaliam a seguranca e a eficacia dos stents farmacologicos em diabeticos no longo prazo. O objetivo deste trabalho foi avaliar os desfechos clinicos tardios nessa populacao de alto risco. METODO: No periodo de maio de 2002 a abril de 2007, todos os pacientes submetidos a intervencao coronaria com stents farmacologicos em dois hospitais foram incluidos no estudo e acompanhados por ate cinco anos. RESULTADOS: No total, 611 pacientes com media de idade de 63,5 ± 11,2 anos foram incluidos neste registro. Os diabeticos (n = 204, 33,4%) apresentaram menor proporcao de pacientes do sexo masculino, maior prevalencia de hipertensao arterial e insuficiencia renal cronica, e menor diâmetro de referencia do vaso em comparacao aos nao-diabeticos. Durante o seguimento, os diabeticos mostraram maior probabilidade de eventos cardiacos adversos combinados (19,7% vs. 13,4%; P = 0,04), em decorrencia de obito (7,4% vs. 2,3%; P = 0,003), infarto agudo do miocardio (5,9% vs. 3,1%; P = 0,10) e trombose do stent definitiva/provavel (3,9% vs. 1,3%; P = 0,04). A revascularizacao do vaso-alvo e a revascularizacao da lesao-alvo, entretanto, nao diferiram entre os grupos (10,9% vs. 9,8%; P = 0,68 e 3,4% vs. 5,1%; P = 0,35, respectivamente). A presenca de diabetes melito foi preditora independente de obito [odds ratio (OR) 2,42; intervalo de confianca de 95% (IC 95%) 1,02-5,78; P = 0,05], mas nao de trombose de stent (OR 2,41; IC 95% 0,76-7,61; P = 0,13), em nossos pacientes. CONCLUSOES: Os resultados deste estudo demonstraram que, em pacientes submetidos a implante de stents farmacologicos, a presenca de diabetes esteve associada a maiores taxas de mortalidade, infarto agudo do miocardio e trombose do stent, comparativamente aos nao-diabeticos. A presenca de taxas similares de revascularizacao da lesao-alvo em diabeticos e nao-diabeticos e promissora e sugere a eficacia da revascularizacao percutânea com implante de stents farmacologicos nessa populacao.

Is there a preferable DES in diabetic patients? A critical appraisal of the evidence

Drug-eluting stent (DES) therapy reduces restenosis in patients with diabetes when compared with bare metal stent implantation. There are significant differences between commercially available DES platforms both in terms of design characteristics and clinical outcomes. Randomized active-comparator inter-DES trials powered for clinical endpoints are unlikely to be performed in patients with diabetes, however, direct comparison randomized trials utilizing surrogate endpoints support a superior anti-restenotic efficacy with sirolimus- versus paclitaxel-eluting stents. Thrombotic stent occlusion may be higher in patients with diabetes compared with nondiabetic patients, though there is no clear signal of a safety differential between the two platforms. Insufficient data on comparative performance in diabetics exist in relation to the approved zotarolimus-eluting and everolimus-eluting stent platforms. If all other factors are equal, then there seems to be no reason why the diabetic patient should not receive treatment with the sirolimus-eluting stent, which appears to have superior antirestenotic efficacy in this patient group.

Response to Letters Regarding Article, “Two-Year Clinical Outcomes With Drug-Eluting Stents for Diabetic Patients With De Novo Coronary Lesions: Results From a Real-World Multicenter Registry”

We thank Barlis and colleagues for their legitimate1 query about the ability of the propensity score regression technique to balance covariates between the somewhat heterogeneous groups. Our decision to report the results of a propensity score regression analysis conducted across the overall study population was based on a number of considerations. Nevertheless, application of propensity score matching (as suggested by Barlis and colleagues) in 2 well-balanced but smaller groups (253 patients each) substantially confirms the main results. Indeed, the result for the main …

Letter by Watada et al Regarding Article, “Two-Year Clinical Outcomes With Drug-Eluting Stents for Diabetic Patients With De Novo Coronary Lesion”

To the Editor: We read with interest the article by Dr Ortolani and coworkers1 on the results of their study of 2-year clinical outcome of drug-eluting stents for diabetic patients. They concluded that the use of drug-eluting stents was associated with a modest reduction in the 2-year risk of target vessel revascularization compared with the use of bare-metal stents. In their study, a significant reduction in risk of major adverse cardiac events by drug-eluting stent implantation was identified in non-insulin-dependent diabetic …

Letter by Barlis et al Regarding Article, “Two-Year Clinical Outcomes With Drug-Eluting Stents for Diabetic Patients With De Novo Coronary Lesions: Results From a Real-World Multicenter Registry

To the Editor: The role of drug-eluting stents within the field of interventional cardiology has recently come under close scrutiny in the wake of increasing concerns about late stent thrombosis and doubts on the overall cost-effectiveness of these devices. The prevailing view among experts, however, is that this technology retains an important role, particularly in patients at high risk of restenosis such as those with diabetes mellitus, as suggested by randomized trials.1 It was thus with great interest that we read the article by Ortolani et al,2 which presents the results …

Clinical Efficacy of Drug-Eluting Stents in Diabetic Patients: A Meta-Analysis

Clinical Efficacy of Drug-Eluting Stents in Diabetic Patients: A Meta-Analysis Ehtisham Mahmud, Guilherme Bromberg-Marin, Vachaspathi Palakodeti, Lawrence Ang, Dana Creanga, Anthony N. DeMaria This meta-analysis was performed to estimate and compare rates of revascularization and major adverse cardiac events (MACE) (death, myocardial infarction, repeat revascularization) in diabetic patients treated with paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES). In 13 randomized controlled trials (n = 2,422), point estimates for target lesion revascularization (PES: 8.6%, 95% confidence interval [CI] 6.5% to 11.3%; SES: 7.6%, 95% CI 5.8% to 9.9%) and MACE (PES: 15.4%, 95% CI 12.4% to 19.1%; SES: 12.9%, 95% CI 8.5% to 19.2%) were similar. In 16 registries (n = 10,156), point estimates for target vessel revascularization (PES: 5.8%, 95% CI 3.9% to 8.5%; SES: 7.2%, 95% CI 4.6% to 11.2%) and MACE (PES: 10.1%, 95% CI 7.3% to 13.8%; SES: 11.9%, 95% CI 8.6% to 16.4%) were also similar. This analysis demonstrates low and similar revascularization and MACE estimates with PES and SES in diabetic patients. The purpose of this study was to compare estimates for revascularization and major adverse cardiac events (MACE) (death, myocardial infarction, repeat revascularization) in diabetic patients treated with paclitaxel- and sirolimus-eluting stents (PES and SES). Outcomes in diabetic patients treated with PES and SES have not been adequately evaluated. We searched MEDLINE/EMBASE from January 2002 to February 2007 and identified abstracts/presentations from this period at major cardiology conferences. Randomized controlled trials (RCTs) and registries were included if data for diabetic patients treated with PES or SES were available. Point estimates with 95% confidence intervals (CIs) were computed as summary statistics. In RCTs (13 trials; n = 2,422) similar point estimates for target lesion revascularization (TLR) (PES: 8.6%, 95% CI 6.5% to 11.3%; SES: 7.6%, 95% CI 5.8% to 9.9%) and MACE (PES: 15.4%, 95% CI 12.4% to 19.1%; SES: 12.9%, 95% CI 8.5% to 19.2%) were observed. In head-to-head trials (4 RCTs), no difference in the likelihood of TLR (PES vs. SES) was observed (odds ratio [OR] 1.37, 95% CI 0.64 to 2.9, p = 0.42). In registries (16 registries; n = 10,156), point estimates for target vessel revascularization (TVR) (PES: 5.8%, 95% CI 3.9% to 8.5%; SES: 7.2%, 95% CI 4.6% to 11.2%) and MACE (PES: 10.1%, 95% CI 7.3% to 13.8%; SES: 11.9%, 95% CI 8.6% to 16.4%) were also similar. In registries reporting outcomes with both stents (8 registries for TVR and 7 registries for MACE), the likelihood of TVR (PES vs. SES) (OR 0.77, 95% CI 0.54 to 1.10, p = 0.15) and MACE (OR 0.83, 95% CI 0.68 to 1.01, p = 0.056) were nonsignificantly lower with PES. This analysis of over 11,000 diabetic patients treated with drug-eluting stents demonstrates single-digit revascularization rates. Furthermore, revascularization and MACE estimates are similar with both PES and SES.

Comparison of bypass surgery with drug-eluting stents for diabetic patients with multivessel

Comparison of bypass surgery with drug-eluting stents for diabetic patients with multivessel

Two-Year Clinical Outcomes With Drug-Eluting Stents for Diabetic Patients With De Novo Coronary Lesions

The long-term effectiveness of drug-eluting stents (DES) in unselected diabetics in routine practice is currently unclear. To evaluate the long-term effectiveness of bare metal stents and DES in a real-world setting of diabetic patients, we analyzed 2-year follow-up data from all diabetic patients with de novo lesions enrolled in a prospective Web-based multicenter registry (Registro Regionale Angioplastiche dell'Emilia-Romagna; study period, 2002 to 2004) comprising all 13 hospitals performing percutaneous coronary interventions in the Emilia-Romagna region of Italy. Among the 1648 eligible patients treated with either bare metal stents alone (n=1089) or DES alone (n=559), 27% were insulin dependent and 83% had multivessel coronary disease. At 2 years, use of DES was associated with lower crude incidence of major adverse cardiac advents (all-cause mortality, nonfatal myocardial infarction, and target vessel revascularization) compared with bare metal stents (22.5% versus 28.1%; P=0.01). After propensity score adjustment, only target vessel revascularization appeared significantly lower in the DES group (11.6% versus 15.0%; hazard ratio, 0.66; 95% confidence interval, 0.46 to 0.96; P=0.041). Two-year angiographic stent thrombosis occurred in 1.5% DES patients and 0.7% of the bare-metal-stents patients (P=0.18). At Cox regression analysis, predictors of 2-year major adverse cardiac advents were left ventricular ejection fraction <35%, Charlson comorbidity index, insulin-dependent diabetes, and total lesion length. In this large, real-world, diabetic population, the use of DES was associated with a moderate reduction in the 2-year risk of target vessel revascularization, a benefit that was limited to non-insulin-dependent diabetic patients. Larger long-term studies are needed to clarify the long-term effectiveness and safety of such devices in diabetic patients.