Impact of diabetes mellitus on one-year outcomes of bioresorbable versus durable polymer drug-eluting stents in patients undergoing percutaneous coronary intervention following rotational atherectomy: Results from a large prospective registry

Patients with diabetes mellitus (DM) have worse outcomes after percutaneous coronary intervention (PCI), even with everolimus-eluting stents (EES). Limited data are available comparing outcomes in DM versus non-DM receiving various bioresorbable polymer (BP) or durable polymer (DP) EES after rotational atherectomy (RA). We aimed to study the impact of DM on outcomes in patients undergoing PCI with BP-EES and DP-EES after RA. Consecutive patients undergoing PCI with RA between 2014 and 2021 were included. The primary outcome was major adverse cardiac events (MACE), a composite of death, myocardial infarction (MI), or stroke at 1 year, which was stratified according to DM status. Regression analysis was performed to adjust for confounders. Among 2376 patients (mean age 70.3 ± 10.7, 49.5 % DM) that underwent RA, 552 received BP-EES and 1824 received DP-EES. Both groups had similar number of stents implanted and stent diameters; however, the BP-EES group had a higher SYNTAX score and was more likely to have multi-vessel disease and undergo PCI to the left anterior descending, circumflex, and right coronary artery. In both BP-EES and DP-EES groups, there was no significant difference in adjusted risk of MACE (BP-EES: 7.3 % vs. 7.1 %, HR 0.78, 95 % CI 0.35–1.78, P = 0.562 & DP-EES: 7.5 % vs. 3.7 %, HR 1.49, 95 % CI 0.89–2.50, P = 0.130) between diabetics and non-diabetics. Despite differences in baseline characteristics, DM was not associated with worse MACE at one year in patients with complex coronary artery disease undergoing RA and PCI with contemporary BP-EES or DP-EES.