Comparison of clinical outcomes between first-generation and second-generation drug-eluting stents in type 2 diabetic patients

BACKGROUND: Drug-eluting stent (DES) implantation has significantly reduced the risk of restenosis and major adverse cardiac event (MACE) rates compared with bare-metal stents in type 2 diabetic patients. Differences in outcomes between the first-generation and second-generation DESs in diabetic patients, however, have yet to be evaluated. AIM: We compared MACEs after second-generation DES implantation compared with those of first-generation stents in diabetic patients. METHODS AND RESULTS: This single-center prospective cohort study compared first-generation DES (n=654) and second-generation DES (n=339) implantation in type 2 diabetic patients by propensity score matching. The primary outcome was the occurrence of MACEs, defined as a composite of all-cause death, nonfatal myocardial infarction, and target vessel revascularization. The rate of MACEs was lower in the second-generation DES group after 2 years of follow-up (3.3 vs. 10.0%, P<0.001). Kaplan-Meier analysis showed higher MACE-free survival in diabetic patients in the second-generation DES group (log-rank P<0.001). In a Cox regression analysis, first-generation DES (hazard ratio=3.60, 95% confidence interval, 2.03-6.37, P<0.001) was an independent predictor for MACEs. CONCLUSION: In type 2 diabetic patients, second-generation DES implantation resulted in lower MACEs compared with first-generation DESs, primarily because of lower target lesion and vessel revascularization rates.