Safety and efficacy of everolimus-eluting stents versus paclitaxel-eluting stents in a diabetic population.

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Citation: Catheterization & Cardiovascular Interventions. 81(5):759-65, 2013 Apr.PMID: 22488756Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal ArticleSubject headings: *Cardiovascular Agents/ad [Administration & Dosage] | *Coronary Artery Disease/th [Therapy] | *Diabetic Angiopathies/th [Therapy] | *Drug-Eluting Stents | *Paclitaxel/ad [Administration & Dosage] | *Percutaneous Coronary Intervention/is [Instrumentation] | *Sirolimus/aa [Analogs & Derivatives] | Aged | Chi-Square Distribution | Coronary Angiography | Coronary Artery Disease/di [Diagnosis] | Coronary Artery Disease/mo [Mortality] | Diabetic Angiopathies/di [Diagnosis] | Diabetic Angiopathies/mo [Mortality] | Disease-Free Survival | District of Columbia | Female | Humans | Kaplan-Meier Estimate | Male | Middle Aged | Multivariate Analysis | Myocardial Infarction/et [Etiology] | Myocardial Infarction/pc [Prevention & Control] | Percutaneous Coronary Intervention/ae [Adverse Effects] | Percutaneous Coronary Intervention/mo [Mortality] | Platelet Aggregation Inhibitors/tu [Therapeutic Use] | Predictive Value of Tests | Proportional Hazards Models | Prosthesis Design | Registries | Retrospective Studies | Risk Assessment | Risk Factors | Sirolimus/ad [Administration & Dosage] | Thrombosis/et [Etiology] | Thrombosis/pc [Prevention & Control] | Time Factors | Treatment Outcome | Ultrasonography, InterventionalLocal holdings: Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006ISSN:
  • 1522-1946
Name of journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & InterventionsAbstract: BACKGROUND: EES have demonstrated superiority in efficacy when compared to PES in a general population. However, it is controversial whether this superiority holds true in a diabetic population.CONCLUSIONS: In a diabetic population undergoing PCI, the use of an EES compared to PES was associated with lower rates of stent thrombosis; but after adjustment the composite TLR-MACE at 1 year was similar between both stents. Copyright 2012 Wiley Periodicals, Inc.METHODS: From March 2004 to May 2010, 968 patients with consecutive diabetes who underwent percutaneous coronary intervention and implantation of an EES (n = 388) or PES (n = 580) at our institution. In-hospital, 1-month, 6-month, and 1-year clinical outcomes were analyzed and compared. Correlates of major adverse cardiac events (MACE) were identified.OBJECTIVES: This study aimed to analyze the use of everolimus-eluting stents (EES) and paclitaxel-eluting stents (PES) in an unrestricted diabetic population and to compare the performance of these two drug-eluting stents.RESULTS: Baseline clinical characteristics were similar between stent types except for more family history of coronary artery disease in the PES group and more insulin-dependent diabetes and unstable angina at initial diagnosis in the EES group. The PES group had higher number of lesions treated, longer stents used, and a higher proportion of intravascular ultrasound and glycoprotein IIb/IIIa inhibitor use. The EES group had more type C and distal lesions. There was higher target lesion revascularization (TLR)-MACE in the PES group (3.3% vs. 1.0%, P = 0.03) as well as a higher rate of stent thrombosis (ST) (8 patients vs. 0 in the EES group, P = 0.03). ST continued to be higher in the PES group at 6 and 12 months and mortality was higher at 12 months in the PES group (9.4% vs. 5.2%, P = 0.02). After adjustment, no significant differences were found between stent types on Cox regression analysis for hazard ratios at 1-year follow-up of TLR-MACE.All authors: Barbash IM, Hauville C, Laynez A, Pakala R, Pichard AD, Sardi G, Satler LF, Torguson R, Waksman R, Xue ZDigital Object Identifier: Date added to catalog: 2013-12-24
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 22488756

Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006

BACKGROUND: EES have demonstrated superiority in efficacy when compared to PES in a general population. However, it is controversial whether this superiority holds true in a diabetic population.

CONCLUSIONS: In a diabetic population undergoing PCI, the use of an EES compared to PES was associated with lower rates of stent thrombosis; but after adjustment the composite TLR-MACE at 1 year was similar between both stents. Copyright 2012 Wiley Periodicals, Inc.

METHODS: From March 2004 to May 2010, 968 patients with consecutive diabetes who underwent percutaneous coronary intervention and implantation of an EES (n = 388) or PES (n = 580) at our institution. In-hospital, 1-month, 6-month, and 1-year clinical outcomes were analyzed and compared. Correlates of major adverse cardiac events (MACE) were identified.

OBJECTIVES: This study aimed to analyze the use of everolimus-eluting stents (EES) and paclitaxel-eluting stents (PES) in an unrestricted diabetic population and to compare the performance of these two drug-eluting stents.

RESULTS: Baseline clinical characteristics were similar between stent types except for more family history of coronary artery disease in the PES group and more insulin-dependent diabetes and unstable angina at initial diagnosis in the EES group. The PES group had higher number of lesions treated, longer stents used, and a higher proportion of intravascular ultrasound and glycoprotein IIb/IIIa inhibitor use. The EES group had more type C and distal lesions. There was higher target lesion revascularization (TLR)-MACE in the PES group (3.3% vs. 1.0%, P = 0.03) as well as a higher rate of stent thrombosis (ST) (8 patients vs. 0 in the EES group, P = 0.03). ST continued to be higher in the PES group at 6 and 12 months and mortality was higher at 12 months in the PES group (9.4% vs. 5.2%, P = 0.02). After adjustment, no significant differences were found between stent types on Cox regression analysis for hazard ratios at 1-year follow-up of TLR-MACE.

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