Key result
The 3-year rates of patient-oriented composite endpoint were similar among 5 contemporary drug-eluting stents in both non-diabetics (13.0%-14.6%, P=0.39) and diabetics (17.3%-20.3%, P=0.44).
Why the study?
Whether diabetic status differentially affects clinical outcomes with different drug-eluting stents has been controversial.
Do different types of contemporary drug-eluting stents have differential clinical outcomes in patients with and without diabetes mellitus?
Cohort (n=17,184)
Yes
Do different types of contemporary drug-eluting stents have differential clinical outcomes in patients with and without diabetes mellitus?
p-value: p=0.39 (non-diabetics), 0.44 (diabetics)
Contemporary drug-eluting stents show similar 3-year clinical outcomes regardless of the specific stent type or the patient's diabetic status.
BACKGROUND: Whether the diabetic status differentially affects the clinical outcomes with different drug-eluting stents (DES) has been controversial. METHODS AND RESULTS: From stent-specific, prospective DES registries, we evaluated 17,184 patients (11,428 in non-diabetics and 5,756 in diabetics) who received several contemporary DES: 3570 sirolimus-eluting stents (SES), 5,023 cobalt-chromium everolimus-eluting stents (CoCr-EES), 2,985 platinum-chromium EES (PtCr-EES), 2,913 Resolute zotarolimus-eluting stents (Re-ZES), and 2,693 biodegradable-polymer biolimus-eluting stents (BP-BES). The primary outcome was patient-oriented composite endpoint (POCE, a composite of all-cause death, any myocardial infarction, and any revascularization) at 3-year follow-up and target-vessel failure (a composite of cardiac death, target-vessel myocardial infarction, and target-vessel revascularization) at 3 years was also evaluated. In non-diabetics, the rates of POCE were not significantly different (CoCr-EES 14.3%, PtCr-EES 13.0%, Re-ZES 14.3%, BP-BES 13.4%, and SES 14.6%; overall p = .39). In diabetics, similar results were revealed (CoCr-EES 18.4%, PtCr-EES 20.3%, Re-ZES 17.3%, BP-BES 17.7%, and SES 17.8%; overall p = .44). In multiple treatment propensity-score weighting analysis, regardless of the diabetic status, the hazard ratios for POCE between-individual comparison were similar. Target-vessel failure (a composite of cardiac death, target-vessel myocardial infarction, and target-vessel revascularization) was also comparable except the higher ratio of Re-ZES than PtCr-EES (hazard ratio 1.25, 1.26, 95% confidence interval 1.00-1.55, p = .048) in patients without diabetes. CONCLUSIONS: In this clinical-practice registry study, regardless the diabetic status, the 3-year rates of the primary outcome were similar among different types of DES, suggesting no differential clinical response between contemporary DES in patients with or without diabetes.
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Kwon et al. (2019) conducted a cohort in Coronary artery disease requiring stenting (n=17,184). Contemporary drug-eluting stents (SES, CoCr-EES, PtCr-EES, Re-ZES, BP-BES) vs. Between-stent comparison was evaluated on Patient-oriented composite endpoint (POCE: all-cause death, any myocardial infarction, and any revascularization) (p=0.39 (non-diabetics), 0.44 (diabetics)). The 3-year rates of patient-oriented composite endpoint were similar among 5 contemporary drug-eluting stents in both non-diabetics (13.0%-14.6%, P=0.39) and diabetics (17.3%-20.3%, P=0.44).
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