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European Heart Journal Advance Access originally published online on November 29, 2006
European Heart Journal 2007 28(1):26-32; doi:10.1093/eurheartj/ehl412
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

The long-term value of sirolimus- and paclitaxel-eluting stents over bare metal stents in patients with diabetes mellitus

Joost Daemen, Hector M. Garcia-Garcia, Neville Kukreja, Farshad Imani, Peter P.T. de Jaegere, Georgios Sianos, Ron T. van Domburg and Patrick W. Serruys*

Thoraxcenter, Erasmus Medical Center, Ba-583 Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands

Received 23 August 2006; revised 8 October 2006; accepted 9 November 2006; online publish-ahead-of-print 29 November 2006.

* Corresponding author. Tel: +31 10 4635260; fax: +31 10 4369154. E-mail address: p.w.j.c.serruys{at}erasmusmc.nl

Aims To investigate the outcome of a real world diabetic patient cohort treated with bare metal stents (BMS), sirolimus-, or paclitaxel-eluting stents (SES and PES, respectively). Due to the different mechanisms of action of both drugs it is currently unknown which device is the best option to treat these high-risk patients.

Methods and results The study compares the 2-year clinical outcome of 708 consecutive diabetic patients (25% insulin treated) treated with either a BMS (n = 252), a SES (n = 206), or a PES (n = 250), as part of the RESEARCH and T-SEARCH registries. Target vessel revascularization was 19.5% in the BMS group, vs. 15.3% in the SES group and 9.7% in the PES group. PES (21.2%), but not SES (28.9%), were superior to BMS (29.7%) in reducing major adverse cardiac events. After propensity analyses, none of the differences remained significant. The incidence of stent thrombosis (ST) was high in both DES groups.

Conclusion There was a trend towards a more favourable outcome associated with the use of PES over BMS. There was no significant difference between SES and PES in each of the clinical endpoints, and neither in the NIDDM patients, which are hypothesized to be better-off with PES.

Key Words: Diabetes • Sirolimus-eluting stent • Paclitaxel-eluting stent • Restenosis


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