Clinical Outcomes Similar in SES, PES-Treated Diabetic Patients

August 7, 2006

By Justin R. McCrary, MD

In medically treated diabetic patients with multivessel coronary artery disease, deployment of sirolimus-eluting stents (SES, Cypher^®, Cordis Corporation) or paclitaxel eluting-stents (PES, Taxus^®, Boston Scientific) makes no difference in in-hospital or 9-month major adverse cardiac events (MACE), according to a recent study published in The American Journal of Cardiology.¹ 

Investigators studied consecutive patients with diabetes mellitus (defined as treatment with oral hypoglycemic agents or insulin at time of admission) who underwent multivessel implantation of either SESs or PESs (N=260).  Patients were followed for a total of 9 months, and follow-up data was obtained on all study subjects.  MACE were defined as death, nonfatal myocardial infarction, and target vessel revascularization. 

In-hospital events were similar between patients who received SESs and those who received PESs (Figure 1).  9-month and cumulative MACE rates were also comparable between the two groups (Figure 2), while there was no statistical difference in the incidence of stent thrombosis (Figure 3).

Insulin-dependent and non-insulin-dependent diabetic patients treated with SES or PES had similar cumulative MACE rates (Figure 4). After adjustment, insulin-dependent diabetes mellitus was an independent predictor of adverse cardiac events (OR 2.68, 95% CI 1.46-4.89, P=0.001).

These results show that there is still a relatively high incidence of MACE rates in the diabetic population with multivessel disease, despite treatment with drug-eluting stents.  Investigators concluded that, "not only continued improvement in drug-eluting stent technology, but also optimal adjunctive pharmacotherapy and control of hyperglycemia will be required to achieve the best clinical outcomes after PCI in patients with diabetes."
 
References

1. Stankovic G, Cosgrave J, Chieffo A, et al. Impact of Sirolimus-Eluting and Paclitaxel-Eluting Stents on Outcome in Patients With Diabetes Mellitus and Stenting in More Than One Coronary Artery. Am J Cardiol 2006;98:362-366.