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European Heart Journal Advance Access originally published online on February 12, 2008
European Heart Journal 2008 29(6):718-725; doi:10.1093/eurheartj/ehn021
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Two-year clinical outcome after implantation of sirolimus-eluting and paclitaxel-eluting stents in diabetic patients

Michael Billinger1, Jonas Beutler1, Keywan R. Taghetchian1, Andrea Remondino1, Peter Wenaweser1, Stéphane Cook1, Mario Togni1, Christian Seiler1, Christoph Stettler2, Franz R. Eberli3, Thomas F. Lüscher3, Simon Wandel2, Peter Jüni2, Bernhard Meier1 and Stephan Windecker1,*

1 Department of Cardiology, University Hospital Bern, 3010 Bern, Switzerland
2 Department of Social and Preventive Medicine, University Hospital Bern, Bern, Switzerland
3 Division of Cardiology, University Hospital Zurich, Zurich, Switzerland

Received 29 June 2007; revised 21 December 2007; accepted 10 January 2008; online publish-ahead-of-print 12 February 2008.

* Corresponding author. Tel: +41 31 632 44 97, Fax: +41 31 632 47 70, Email: stephan.windecker{at}insel.ch

Aims: Percutaneous coronary intervention (PCI) in diabetic patients is associated with an increased risk of restenosis and major adverse cardiac events (MACE). We assessed the impact of diabetes on long-term outcome after PCI with sirolimus-eluting (SES) and paclitaxel-eluting (PES) stents.

Methods and results: In the SIRTAX trial, 1012 patients were randomized to treatment with SES (n = 503) or PES (n = 509). A stratified analysis of outcomes was performed according to the presence or absence of diabetes. Baseline characteristics were well balanced between SES and PES in patients with (N = 201) and without diabetes (N = 811). Clinical outcome was worse in diabetic compared with non-diabetic patients regarding death (9.0% vs. 4.1%, P = 0.004) and MACE (defined as cardiac death, myocardial infarction, or TLR; 19.9% vs. 12.7%, P = 0.007) at 2 years. Among diabetic patients, SES reduced MACE by 47% (14.8% vs. 25.8%, HR = 0.52, P = 0.05) and TLR by 61% (7.4% vs. 17.2%, HR = 0.39, P = 0.03) compared with PES at 2 years.

Conclusion: Diabetic patients have worse prognosis than non-diabetic patients undergoing PCI with DES. Among the diabetic patient population of this trial, SES reduce repeat revascularization procedures and MACE more effectively than PES and to a similar degree as in non-diabetic patients.

Key Words: Coronary disease • Stents • Drugs • Restenosis • Diabetes


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