European Heart Journal Advance Access published online on June 11, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm197
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Long-term clinical benefit of sirolimus-eluting stent implantation in diabetic patients with de novo coronary stenoses: long-term results of the DIABETES trial
1 Servicio de Cardiología Intervencionista, Cardiovascular Institute, San Carlos University Hospital, Madrid 28040, Spain
2 do Meixoeiro University Hospital, Vigo, Spain
3 ‘Prínceps d'Espanya’ University Hospital, Barcelona, Spain
4 Research Unit, San Carlos University Hospital, Madrid, Spain
5 Clínico University Hospital, Valladolid, Spain
Received 3 January 2007; revised 14 March 2007; accepted 19 April 2007.
* Corresponding author. Tel: +34 913303283; fax: +34 913303291. E-mail address: manelsabate1{at}telefonica.net
Aims: Sirolimus stent implantation has been demonstrated to be safe and effective in diabetics; however, the long-term outcomes in this high-risk population remain unknown. The aim of this study was to determine the long-term safety and efficacy of the sirolimus-eluting stent (SES) when compared with the bare metal stent (BMS) in patients included in the DIABETES (DIABETes and sirolimus Eluting Stent) trial.
Methods and results: The prospective multicentre DIABETES trial randomized 160 diabetic patients with one or more significant coronary stenoses in one, two, or three vessels to either SES or BMS implantation. One-year dual antiplatelet therapy (aspirin plus clopidogrel) was routinely prescribed. Clinical follow-up was scheduled at 1, 9, 12, and 13 months and 2 years. Baseline clinical and angiographic characteristics were comparable between groups. At 2 years, the rate of target lesion revascularization was significantly lower in the SES group compared with the BMS group (7.7 vs. 35.0%, P < 0.001). However, the total revascularization rate at 2 years increased in both groups due to progression of atherosclerosis in coronary segments remote from the target lesion (rate of atherosclerosis progression: 7.7% in SES group vs. 10% in BMS group; P = 0.7). During dual antiplatelet treatment (1 year), there was no stent thrombosis in the SES group, whereas two patients presented it in the BMS group. However, after clopidogrel withdrawal, three patients allocated to the SES group presented stent thromboses vs. none in the BMS group.
Conclusion: SES implantation in diabetic patients remains effective at 2-year follow-up. However, clinical efficacy appeared to be reduced by the occurrence of stent thrombosis between 1 and 2 years.
Key Words: Sirolimus-eluting stent • Restenosis • Diabetes mellitus • Stent thrombosis • Target lesion revascularization • Trial