1
|
Acute coronary syndromes in diabetic patients, outcome, revascularization, and antithrombotic therapy. Biomed Pharmacother 2022; 148:112772. [PMID: 35245735 DOI: 10.1016/j.biopha.2022.112772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 01/08/2023] Open
Abstract
Diabetes exacerbates the progression of atherosclerosis and is associated with increased risk of developing acute coronary syndrome (ACS). Approximatively 25-30% of patients admitted for ACS have diabetes. ACS occurs earlier in diabetics and is associated with increased mortality and a higher risk of recurrent ischemic events. An increased proinflammatory and prothrombotic state is involved in the poorer outcomes of diabetic patients. In the past decade advancement in both percutaneous coronary intervention (PCI) and coronary artery by-pass graft (CABG) techniques and more potent antiplatelet drugs like prasugrel and ticagrelor improved outcomes of diabetic patients with ACS, but this population still experiences worse outcomes compared to non-diabetic patients. While in ST elevation myocardial infarction urgent PCI is the method of choice for revascularization, in patients with non-ST elevation ACS an early invasive approach is suggested by the guidelines, but in the setting of multivessel (MV) or complex coronary artery disease (CAD) the revascularization strategy is less clear. This review describes the accumulating evidence regarding factors involved in promoting increased incidence and poor prognosis of ACS in patients with diabetes, the evolution over time of prognosis and outcomes, revascularization strategies and antithrombotic therapy studied until now.
Collapse
|
2
|
Sharma K, Dani S, Desai D, Kumar P, Bhalani N, Vasavada A, Trivedi R. Two-year safety and efficacy of Indigenous Abluminus Sirolimus Eluting Stent. Does it differ amongst diabetics? - Data from en-ABLe- REGISTRY. J Cardiovasc Thorac Res 2021; 13:162-168. [PMID: 34326971 PMCID: PMC8302901 DOI: 10.34172/jcvtr.2021.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: To evaluate the efficacy/safety profile of the Abluminus DES+ over 2-years follow-up in the "real-world" scenario in diabetics as compared to non-diabetics. Methods: In prospective, all-comers, open-label registry conducted at 31 sites, patients were analyzed for 1 & 2-year outcomes with the primary endpoint defined as 3P-MACE of CV death, target vessel related myocardial infarction (TV-MI), ischemia-driven target lesion revascularization (TLR)/target vessel revascularization (TVR) apart from Stent thrombosis (ST). Results: Of 2500 patients of PCI with 3286 Abluminus-DES+, 1641 (65.64%) were non-diabetics while859 (34.36%) were diabetics. The 3-P MACE for the cohort at 1 & 2 years were 2.9%, and 3.16%; TLR/TVR - 1.4% at both the intervals for 2493 patients at 2 yrs. follow-up. TV-MI & ST were 0.36% and0.56% at 1st and 2nd year respectively. The 3P-MACE was lower in non-diabetics at 1 & 2 years (2.3%vs 4.2%; 2.4% vs 4.7% respectively). For components of MACE, CV mortality (0.9 vs 1.9% at 1 yr ; 1.0vs 2.1% at 2 years) was significant (P < 0.05) while TLR (1.1 vs 1.9% at 1 yr. & 1.1 vs 2.1% at 2 yrs.) and TV-MI (0.9 vs 1.9% at 1 yr. & 1 vs 2.1% at 2 years) were similar for diabetics and non-diabetics so was ST (P > 0.05). Conclusion: Abluminus-DES+ showed excellent 2-year safety and efficacy with low 3-P MACE which was higher in diabetics driven by higher CV death but similar TLR, TV-MI and ST.
Collapse
Affiliation(s)
- Kamal Sharma
- Department of Cardiology, UNMICRC, BJ Medical College, Ahmedabad (Gujarat), India
| | - Sameer Dani
- Apollo Hospitals Ahmedabad and Limsar, Ahmedabad (Gujarat), India
| | - Devang Desai
- Unicare Hospital, Mahavir Hospital, Surat (Gujarat) India
| | - Prathap Kumar
- ESIC Hospital Kollam and Meditrina Hospital, Kerala, India
| | - Nirav Bhalani
- Rhythm Hopsital and Sunshine Global, Vadodara (Gujarat), India
| | | | | |
Collapse
|
3
|
Park KH, Jeong MH, Hong YJ, Ahn Y, Kim HK, Koh YY, Kim DI, Kim SW, Kim W, Rha SW, Rhew JY, Park JS, Park HS, Bae JH, Bae JW, Oh SK, Lee SY, Lee SW, Lee JH, Lim SY, Cho JH, Cha KS, Chae JK, Hur SH, Hwang SH, Hwang JY. Effectiveness and Safety of Biolimus A9™-Eluting stEnt in Patients with AcUTe Coronary sYndrome; A Multicenter, Observational Study (BEAUTY Study). Yonsei Med J 2018; 59:72-79. [PMID: 29214779 PMCID: PMC5725367 DOI: 10.3349/ymj.2018.59.1.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/02/2017] [Accepted: 11/07/2017] [Indexed: 12/02/2022] Open
Abstract
PURPOSE This study sought to determine the 1-year clinical effectiveness and safety of a biodegradable, polymer-containing Biolimus A9™-eluting stent (BES) in Korean patients with acute coronary syndrome (ACS). MATERIALS AND METHODS A total of 1000 ACS patients with 1251 lesions who underwent implantation of BESs at 22 centers in Korea were enrolled between May 2011 and July 2013. We assessed major adverse cardiac events (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinical-driven target vessel revascularization at 12 months. RESULTS Patient mean age was 62.6±11.4 years. 72.8% of the patients were male, 28.5% had diabetes, 32.8% had multi-vessel disease (MVD), and 47.9% presented with acute MI (AMI). The mean global registry of acute coronary events risk score of all patients was 103.0±27.6. The number of stents per patient was 1.3±0.6. The incidences of MACE and definite stent thrombosis at 12 months were 3.9% and 0.2%, respectively. On multivariate Cox-regression analysis, age ≥65 years was identified as an independent predictors of 1-year MACE (hazard ratio=2.474; 95% confidence interval=1.202-5.091). Subgroup analyses revealed no significant differences in the incidence of MACE between patients with and without diabetes (4.3% vs. 3.7%, p=0.667), between those who presented with and without AMI (4.4% vs. 3.4%, p=0.403), and between those with and without MVD (4.6% vs. 3.5%, p=0.387). CONCLUSION Our study demonstrated excellent 1-year clinical outcomes of BES implantation in patients at low-risk for ACS.
Collapse
Affiliation(s)
- Keun Ho Park
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
| | - Young Joon Hong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Kuk Kim
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Young Yub Koh
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Doo Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Sang Wook Kim
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Weon Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Seung Woon Rha
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jay Young Rhew
- Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Jong Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Hun Sik Park
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jang Ho Bae
- Division of Cardiology, Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea
| | - Jang Whan Bae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Seok Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Sung Yun Lee
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Seung Wook Lee
- Division of Cardiology, Department of Internal Medicine, Gwangju Christian Hospital, Gwangju, Korea
| | - Jae Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sang Yeob Lim
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jang Hyun Cho
- Division of Cardiology, Department of Internal Medicine, Saint Carollo Hospital, Suncheon, Korea
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Jai Keon Chae
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Seung Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Sun Ho Hwang
- Division of Cardiology, Department of Internal Medicine, Gwangju Veterans Hospital, Gwangju, Korea
| | - Jin Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| |
Collapse
|
4
|
Bundhun PK, Soogund MZS, Pursun M, Chen MH. Stent thrombosis and adverse cardiovascular outcomes observed between six months and five years with sirolimus-eluting stents and other drug-eluting stents in patients with Type 2 diabetes mellitus complicated by coronary artery disease: A systematic review and meta-analysis. Medicine (Baltimore) 2016; 95:e4130. [PMID: 27399125 PMCID: PMC5058854 DOI: 10.1097/md.0000000000004130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
This study aimed to compare 6 months to 5 years stent thrombosis (ST) and adverse cardiovascular outcomes associated with sirolimus-eluting stents (SES) and other drug-eluting stents (DES) in patients with type 2 diabetes mellitus (T2DM).Electronic databases were searched for studies comparing SES with other DES in patients with T2DM. Total ST, definite ST, probable ST, and other adverse cardiovascular outcomes reported between 6 months and 5 years were considered as the clinical end points in this study. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for categorical variables and the pooled analyses were performed with RevMan 5.3 software.Twenty-nine studies involving a total number of 25,729 patients with diabetes were included in this meta-analysis. SES were not associated with significantly higher total, definite, and probable STs with OR: 0.95, 95% CI: 0.77-1.17, P = 0.62; OR: 0.94, 95% CI: 0.65-1.37, P = 0.76; and OR: 1.05, 95% CI: 0.77-1.45, P = 0.74, respectively. SES were also noninferior to the other non-sirolimus eluting drug eluting stents (non-SE DES) in terms of all-cause mortality, cardiac death, myocardial infarction, and stroke with OR: 0.92, 95% CI: 0.82-1.03, P = 0.16; OR: 1.09, 95% CI: 0.88-1.35, P = 0.44; OR: 0.92, 95% CI: 0.80-1.06, P = 0.26; and OR: 0.79, 95% CI: 0.49-1.28, P = 0.43, respectively. Target vessel revascularization, target lesion revascularization, and major adverse cardiac events were also similarly reported between SES and non-SE DES with OR: 1.04, 95% CI: 0.83-1.31, P = 0.72; OR: 1.25, 95% CI: 0.95-1.64, P = 0.11; and OR: 1.06, 95% CI: 0.90-1.25, P = 0.49, respectively.During this particular follow-up period, SES were not associated with any increase in ST among these patients with T2DM. Mortality and other adverse cardiovascular outcomes were also not significantly different between these 2 groups. Hence, SES should be considered neither superior nor inferior to other DES. They are expected to be equally effective and safe to use in patients with T2DM.
Collapse
Affiliation(s)
| | | | - Manish Pursun
- Guangxi Medical University, Nanning, Guangxi, PR China
| | - Meng-Hua Chen
- Institute of Cardiovascular Diseases, the First Affiliated Hospital
- Correspondence: Meng-Hua Chen, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, 530027, PR China (e-mail: )
| |
Collapse
|
5
|
Liu Y, Gao L, Song Y, Chen L, Xue Q, Tian J, Wang Y, Chen Y. Efficacy and safety of limus-eluting versus paclitaxel-eluting coronary artery stents in patients with diabetes mellitus: A meta-analysis. Int J Cardiol 2015; 184:680-691. [DOI: 10.1016/j.ijcard.2015.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 02/07/2015] [Indexed: 10/24/2022]
|
6
|
Kubo T, Akasaka T, Tanimoto T, Takano M, Seino Y, Nasu K, Itoh T, Mizuno K, Okura H, Shinke T, Kotani JI, Ito S, Yokoi H, Muramatsu T, Nakamura M, Nanto S. Assessment of vascular response after drug-eluting stents implantation in patients with diabetes mellitus: an optical coherence tomography sub-study of the J-DESsERT. Heart Vessels 2015; 31:465-73. [PMID: 25630713 DOI: 10.1007/s00380-015-0636-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/16/2015] [Indexed: 12/26/2022]
Abstract
Even in the drug-eluting stent era, diabetes mellitus (DM) patients have high incidences of restenosis and repeat revascularization after percutaneous coronary intervention. The aim of this study was to compare vascular response after stent implantation between sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) by using optical coherence tomography (OCT) in DM patients as well as in non-DM patients. In the Japan-Drug Eluting Stents Evaluation; a Randomized Trial (J-DESsERT), the OCT sub-study enrolled 75 patients who underwent 8 months follow-up imaging after SES or PES implantation. Mean neointimal hyperplasia (NIH) thickness was significantly thinner in SES than PES in the DM group (77 ± 47 vs. 201 ± 114 μm, p < 0.001) and in the non-DM group (84 ± 37 vs. 212 ± 128 μm, p < 0.001). Unevenness of NIH thickness in longitudinal axis was significantly smaller in SES than PES in the DM group (348 ± 191 vs. 726 ± 385 μm, p < 0.001) and in the non-DM group (344 ± 174 vs. 679 ± 314 μm, p < 0.001). The percentage of uncovered struts was significantly greater in SES than PES in the DM group (24 ± 4 vs. 9 ± 14 %, p < 0.001) and in the non-DM group (16 ± 16 vs. 3 ± 4 %, p = 0.002). Compared with PES, SES showed more potent NIH inhibition in DM patients as well as in non-DM patients.
Collapse
Affiliation(s)
- Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8510, Japan.
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8510, Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8510, Japan
| | - Masamichi Takano
- Cardiovascular Center, Nippon Medical School, Chiba-Hokusoh Hospital, Chiba, Japan
| | - Yoshitane Seino
- Department of Cardiology, Hoshi General Hospital, Koriyama, Japan
| | - Kenya Nasu
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical School, Morioka, Japan
| | - Kyoichi Mizuno
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroyuki Okura
- Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jun-Ichi Kotani
- Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigenori Ito
- Division of Cardiology, Nagoya City East Medical Center, Nagoya, Japan
| | - Hiroyoshi Yokoi
- Cardiovascular Medicine Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Toshiya Muramatsu
- Division of Cardiology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University, Tokyo, Japan
| | - Shinsuke Nanto
- Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
7
|
Katz P, Leiter LA, Mellbin L, Rydén L. The clinical burden of type 2 diabetes in patients with acute coronary syndromes: prognosis and implications for short- and long-term management. Diab Vasc Dis Res 2014; 11:395-409. [PMID: 25187508 DOI: 10.1177/1479164114546854] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with increased morbidity and mortality in patients with acute coronary syndromes (ACS). Cardiometabolic risk factors, including hyperglycaemia, insulin resistance, atherogenic dyslipidaemia, increased visceral fat and inflammation, are associated with increased risk in this population and represent potential targets for treatment. In this review, management strategies for patients with T2DM post-ACS, both in the acute-care setting and in the long-term, are discussed. Although the benefits of long-term, aggressive, multifactorial risk factor modification are well established, a significant burden of recurrent events remains and the search for novel strategies continues. Several studies are assessing the potential cardiovascular (CV) benefits and safety of various classes of newer agents. Of these, AleCardio (aleglitazar), Examination of Cardiovascular Outcomes With Alogliptin versus Standard of Care in Patients With Type 2 Diabetes Mellitus and Acute Coronary Syndrome (EXAMINE; alogliptin) and Evaluation of LIXisenatide in Acute Coronary Syndrome (ELIXA; lixisenatide) specifically address patients with type 2 diabetes post-ACS. The mechanisms of action of these new therapies and aims of the CV outcome studies are briefly reviewed. The prevalence of type 2 diabetes continues to increase worldwide highlighting the need for new strategies that address the complex underlying processes that drive atherosclerosis and CV events in this high-risk patient population.
Collapse
Affiliation(s)
- Pamela Katz
- Division of Endocrinology & Metabolism, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Lawrence A Leiter
- Division of Endocrinology & Metabolism, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada Departments of Medicine and Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Linda Mellbin
- Cardiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lars Rydén
- Cardiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
8
|
Head-to-head comparison of sirolimus-eluting stents versus paclitaxel-eluting stents in patients undergoing percutaneous coronary intervention: a meta-analysis of 76 studies. PLoS One 2014; 9:e97934. [PMID: 24844284 PMCID: PMC4028235 DOI: 10.1371/journal.pone.0097934] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 04/26/2014] [Indexed: 11/19/2022] Open
Abstract
Background The relative short-, long- and overall-term efficacy and safety of sirolimus-eluting stents (SES, Cypher) compared with paclitaxel-eluting stents (PES, Taxus) in large head-to-head comparisons still remain to be defined. Methods We searched Pubmed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) for articles comparing outcomes of interest between SES and PES without language restriction. Short- (≤1 year), long- (>1 year), and overall-term (the longest follow-up of each study) outcomes were evaluated. The primary endpoint was target lesion revascularization (TLR). Other outcomes of interest were target vessel revascularization (TVR), myocardial infarction, all-cause death, cardiac death, stent thrombosis, major adverse cardiac events (MACEs), restenosis and late lumen loss. Results Seventy-six studies including more than 15000 patients in randomized controlled trials and over 70000 patients in adjusted observational studies were included. At overall-term follow-up, SES significantly reduced TLR (relative risk [RR]: 0.61; 95% confidence interval [CI]: 0.49–0.76), TVR (RR: 0.67; 95% CI: 0.54–0.83), MACE (RR: 0.79; 95% CI: 0.72–0.87), myocardial infarction (RR: 0.85; 95% CI: 0.73–0.99), in-segment restenosis (RR: 0.50; 95% CI: 0.38–0.65), and in-segment late lumen loss (weighted mean difference [WMD]: −0.19; 95% CI: −0.24–−0.14) in randomized controlled trials compared with PES. In addition, lower rates of death (RR: 0.91; 95% CI: 0.83–1.00), any stent thrombosis (RR: 0.62; 95% CI: 0.45–0.86), definite stent thrombosis (RR: 0.59; 95% CI: 0.45–0.77) were found in patients receiving SES in adjusted observational studies. Largely similar results were found at short- and long-term follow-up, and in patients with diabetes, acute myocardial infarction or long lesions. Conclusions SES significantly reduced the short-, long- and overall-term risk of TLR/TVR, MACE, and restenosis, and overall-term risk of myocardial infarction in randomized controlled trials, as compared with PES. Lower rates of death and stent thrombosis were also observed in observational studies in SES-treated patients.
Collapse
|
9
|
Kang SH, Park KH, Ahn HS, Park KW, Hong YJ, Koo BK, Jeong MH, Kim HS. Everolimus-eluting versus sirolimus-eluting coronary stents in patients with and without diabetes mellitus. EUROINTERVENTION 2014; 10:74-82. [DOI: 10.4244/eijv10i1a13] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
10
|
Sirolimus-eluting versus paclitaxel-eluting stents in diabetic and non-diabetic patients within sirolimus-eluting stent restenosis: Results from the ISAR-DESIRE 2 trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:69-75. [DOI: 10.1016/j.carrev.2014.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 02/09/2014] [Accepted: 02/10/2014] [Indexed: 01/22/2023]
|
11
|
Harskamp RE, Park DW. Percutaneous coronary intervention in diabetic patients: should choice of stents be influenced? Expert Rev Cardiovasc Ther 2014; 11:541-53. [DOI: 10.1586/erc.13.38] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
12
|
Wisløff T, Atar D, Sønbø Kristiansen I. Cost effectiveness of drug-eluting stents as compared with bare metal stents in patients with coronary artery disease. Am J Ther 2013; 20:596-601. [PMID: 21822114 DOI: 10.1097/mjt.0b013e3182211a01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The aim of this study was to estimate the incremental cost effectiveness of replacing bare metal stents (BMS) by drug-eluting stents (DES) when using trial data and registry data. We developed a Markov model (model of cost effectiveness of coronary artery disease) in which 60-year-old patients started by undergoing percutaneous coronary intervention for acute or subacute coronary artery disease. The patients are followed until death or 100 years of age. Data on the occurrence of events (revascularization, acute myocardial infarction, and death) were based on Scandinavian registry data. Separate analyses were conducted with data on effectiveness based on randomized controlled trials and patient registries. On using trial data, it was found that sirolimus-eluting stents (SES) yield 0.003 greater life expectancy and $3300 lower costs than do BMS (dominant strategy). Paclitaxel-eluting stents (PES) yield 0.148 more life years than do SES at additional lifetime costs of $2800 ($21,400 per life year gained). On using registry data, the cost per life year gained was found to be $4900 when replacing BMS with DES. Probabilistic sensitivity analyses, on the other hand, indicate that PES only has a 50%-75% probability of being cost effective, regardless of the type of effectiveness data. DESs are cost effective with current willingness to pay for life year gains. Whether PES or SES is the most effective DES remains uncertain.
Collapse
Affiliation(s)
- Torbjørn Wisløff
- 1Health Economics and Drug Unit, Norwegian Knowledge Centre for the Health Services; 2Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Norway; 3Department of Cardiology B, Oslo University Hospital Ullevål; and 4Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | | | | |
Collapse
|
13
|
Abstract
This review aims to describe new developments in coronary revascularization strategies for patients with pre-existing Type 2 diabetes mellitus (DM). Recommended strategies for revascularization have been an active area of study with recent important developments. In patients with Type 2 DM and multivessel coronary artery disease (CAD), coronary artery bypass graft (CABG) surgery is the preferred method for revascularization. Patients with DM are at increased risk for diffuse cardiovascular disease due to the proinflammatory, prothrombotic effects of chronic hyperglycemia. In patients undergoing percutaneous coronary intervention, drug-eluting stents and more potent antiplatelet agents especially in those presenting with acute coronary syndromes should be employed.
Collapse
Affiliation(s)
- Sharon S Choi
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | |
Collapse
|
14
|
Qin SY, Zhou Y, Jiang HX, Hu BL, Tao L, Xie MZ. The association of diabetes mellitus with clinical outcomes after coronary stenting: a meta-analysis. PLoS One 2013; 8:e72710. [PMID: 24066025 PMCID: PMC3774683 DOI: 10.1371/journal.pone.0072710] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 07/15/2013] [Indexed: 11/18/2022] Open
Abstract
Background Previous studies have shown inconsistent results on the association between diabetes mellitus (DM) and some clinical outcomes. We conducted a meta-analysis of observational studies to assess effect of DM on clinical outcomes after coronary stenting. Methods We searched for studies without language restriction in PubMed, Embase and Cochrane library prior to 2012. The clinical outcomes including in-stent restenosis (ISR), major adverse cardiac events (MACE), stent thrombosis (ST), target lesion revascularization (TLR) and target vessel revascularization (TVR). Adjusted odds ratio (OR), and the corresponding 95% confidence interval (95% CI) was summarized. Results 55 studies involving 128,084 total patients (38,416 DM patients and 89,668 controls) were eligible for our analysis. Overall, there were significant associations between DM and ISR (OR = 1.70, 95% CI: 1.53–1.89, I2 = 0.0%), MACE (OR = 1.54, 95% CI: 1.36–1.73, I2 = 29.0%), ST (OR = 2.01, 95% CI: 1.36–2.97, I2 = 47.7%), TLR (OR = 1.46, 95% CI: 1.26–1.68, I2 = 43.3%) as well as TVR (OR = 1.33, 95% CI: 1.17–1.51, I2 = 48.3). Subgroup analysis showed that the associations were similar between BMS and DES implantation. Moreover, there was no significant association in the ST subgroup after 1–3 years follow-up. Conclusions Our meta-analysis suggests that after coronary stent implantation, DM is associated with ISR, MACE, ST, TLR and TVR. DM appears to be a vital risk factor of these clinical outcomes.
Collapse
Affiliation(s)
- Shan-Yu Qin
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - You Zhou
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Hai-Xing Jiang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
- * E-mail:
| | - Bang-Li Hu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - Lin Tao
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - Min-zhi Xie
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| |
Collapse
|
15
|
Harskamp RE, Park DW. Optimal choice of coronary revascularization and stent type in diabetic patients with coronary artery disease. Cardiol Ther 2013; 2:69-84. [PMID: 25135290 PMCID: PMC4107438 DOI: 10.1007/s40119-013-0014-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Indexed: 01/13/2023] Open
Abstract
Patients with diabetes mellitus (DM) are prone to a diffuse and accelerated form of coronary artery disease (CAD), which in turn is a major cause of cardiac-related morbidity and mortality. Compared with patients without diabetes, patients with diabetes undergoing coronary revascularization are at higher risk of procedural, short-, and long-term cardiovascular events and mortality. Although coronary artery bypass grafting (CABG) has been regarded as the primary revascularization strategy in diabetic patients with complex CAD, percutaneous coronary intervention (PCI) is an effective revascularization alternative, due to remarkable advances in stent devices and adjunctive drug therapies. Outcomes data, from subgroup analyses and small-sized clinical trials and large registries, have suggested that PCI with current stent technology showed comparable long-term risks of mortality and hard endpoints, but higher risk of repeat revascularization for the diabetic population compared to CABG. However, the recent landmark International Future REvascularization Evaluation in patients with diabetes mellitus: optimal management of Multivessel disease (FREEDOM) trial provides compelling evidence of the superiority of CABG over PCI in reducing the rates of death, myocardial infarction, at the expense of stroke, in patients with diabetes with advanced CAD. When opting for PCI in patients with diabetes, currently used drug-eluting stents (DES) are more efficient in reducing the risk of repeat revascularization without compromising safety outcomes, compared to bare-metal stents. The selection of a specific type of DES in patients with diabetes is controversial and therefore more data comparing second- and newer-generation DES for patients with diabetes are currently needed. Also, efforts to make more advanced DES platforms suitable for patients with diabetes with complicated angiographic features are still ongoing.
Collapse
Affiliation(s)
- Ralf E Harskamp
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
16
|
Li Y, Han Y, Zhang L, Jing Q, Wang X, Yan G, Ma Y, Wang G, Wang S, Chen X, Yang L, Zhu G, Liu H, Jiang T. Clinical efficacy and safety of biodegradable polymer-based sirolimus-eluting stents in patients with diabetes mellitus insight from the 4-year results of the create study. Catheter Cardiovasc Interv 2013; 81:1127-33. [PMID: 22945767 DOI: 10.1002/ccd.24649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 08/30/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Diabetes mellitus is an independent predictor of adverse clinical events after drug-eluting stent implantation. OBJECTIVES The objective of this study is to evaluate the long-term clinical efficacy and safety of biodegradable polymer-based sirolimus-eluting stents in diabetic versus non-diabetic patients. METHODS A total of 2077 "all comers," including 440 (21.2%) diabetic patients and 1637 (78.8%) non-diabetic patients, were prospectively enrolled in the CREATE study at 59 centers in four countries. The recommended antiplatelet regimen was clopidogrel and aspirin for 6 months followed by chronic aspirin therapy. The primary outcome was the rate of major adverse cardiac events (MACE), defined as a composite of cardiac death, non-fatal myocardial infarction (MI), and target lesion revascularization (TLR). RESULTS Diabetic patients had higher risks of all-cause death (8.2% vs. 3.4%, P < 0.001) and cardiac death (4.1% vs. 1.4%, P < 0.001) compared with non-diabetic patients at 4 years. The rates of non-fatal MI (0.2% vs. 0.9%, P = 0.218), TLR (2.0% vs. 2.8%, P = 0.357), MACE (5.9% vs. 4.4%, P = 0.227), and overall stent thrombosis (1.6% vs. 1.6%, P = 0.932) were not significantly different between diabetic and non-diabetic patients. A landmark analysis showed that prolonged clopidogrel therapy (>6 months) was not beneficial in reducing the cumulative hazards of MACE either in diabetic or non-diabetic patients (log rank P = 0.810). CONCLUSIONS Biodegradable polymer-based sirolimus-eluting stents for the treatment of diabetic patients had a similar clinical event rate at 4 years compared with non-diabetic patients, except for a higher mortality rate.
Collapse
Affiliation(s)
- Yi Li
- Shenyang Northern Hospital, Shenyang, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Barone-Rochette G, Machecourt J, Vanzetto G, Foote A, Quesada JL, Castelli C, Danchin N, Combescure C. The favorable price evolution between bare metal stents and drug eluting stents increases the cost effectiveness of drug eluting stents. Int J Cardiol 2013; 168:1466-71. [PMID: 23336951 DOI: 10.1016/j.ijcard.2012.12.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 11/25/2012] [Accepted: 12/24/2012] [Indexed: 01/21/2023]
Abstract
AIMS We aimed to assess the cost effectiveness of the sirolimus-eluting stent (SES) in diabetic and non-diabetic patients vs. bare metal stents (BMS). METHODS EVASTENT was a matched cohort registry of patients undergoing revascularization exclusively with SES; for each diabetic patient (db+) included, stratified according to single (SVD) or multiple (MVD) vessel disease, a non-diabetic patient (db-) was subsequently included. Efficacy, safety and cost data were obtained from the SES database, and then data from the BMS group were derived by using an original method of transition probabilities of events (Markov model and Monte Carlo simulations) if BMS had been implanted in the same patient, over a 3-year time period. Sensitivity analysis was performed by varying the price difference between BMS and SES from 2008 to 2012. RESULTS In this study, 1731 patients were included with 97% complete follow-up at 3-years. In 2008, compared to BMS the SES was cost effective only in MVD db+ (7494€ per avoided revascularization (PAR) vs. >10,000€ in other groups). In 2012, after a reduction in the price difference between SES and BMS, SES were cost effective in MVD db+ (-891), SVD db+ (3519), MVD db- (3050), and SVD db- (6329) patients. Otherwise, the cardiovascular mortality rate was higher (p<0.0001) in MVD db+ than in SVD db+, MVD db- and SVD db-. CONCLUSION The SES is now cost effective in diabetic and non-diabetic patients, after a favorable price evolution between drug eluting and bare metal stents.
Collapse
Affiliation(s)
- Gilles Barone-Rochette
- Cardiology Department, Grenoble University Hospital, France; INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Hillegass WB, Patel MR, Klein LW, Gurm HS, Brennan JM, Anstrom KJ, Dai D, Eisenstein EL, Peterson ED, Messenger JC, Douglas PS. Long-Term Outcomes of Older Diabetic Patients After Percutaneous Coronary Stenting in the United States. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.993] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
19
|
Tsujita H, Hamazaki Y, Nishikura T, Yokota H, Kondo S, Hosokawa S, Tsukamoto S, Mutou M, Sakurai M, Nishimura H, Kobayashi Y. Sirolimus-eluting stents versus paclitaxel-eluting stents for coronary intervention in patients with renal failure on hemodialysis. Cardiovasc Interv Ther 2012; 28:9-15. [DOI: 10.1007/s12928-012-0103-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 02/01/2012] [Indexed: 10/27/2022]
|
20
|
Differences in clinical and angiographic outcomes with different drug-eluting stents in Japanese patients with and without diabetes mellitus. J Cardiol 2012; 60:361-6. [PMID: 22890073 DOI: 10.1016/j.jjcc.2012.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/20/2012] [Accepted: 06/09/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) is associated with worse clinical outcomes, the efficacy of drug-eluting stents (DES) in Japanese patients and differences in effectiveness between different DES types remain unknown. METHODS AND SUBJECTS Five-hundred and sixty-two consecutive patients (183 with DM, 379 without DM) with 676 lesions were treated with sirolimus-eluting stents (SES, n=531; 160 DM group, 371 non-DM group) or paclitaxel-eluting stents (PES, n=145; 64 and 81, respectively). We assessed the initial and 8-month follow-up clinical and angiographic outcomes. RESULTS There were no significant differences in clinical and lesion characteristics, although the pre-minimum luminal diameter was smaller in the DM group (p=0.016). The risk of major adverse cardiac events (MACE), defined as cardiac death, non-fatal myocardial infarction, congestive heart failure, or recurrent angina pectoris, was higher in the DM group compared with the non-DM group (17.4% vs 9.5%, p=0.007). Among diabetic patients, although SES reduced late loss by 0.45 mm (p<0.001) and the binary restenosis rate by 66.4% (7.4% vs 22.0%, p<0.001) compared with PES at 8 months, it did not reduce target lesion revascularization or MACE, as in the non-DM group. CONCLUSIONS Diabetic patients have worse mid-term prognosis than non-diabetic patients undergoing PCI with DES. Although the superiority of SES in terms of late loss or restenosis may not play a clinically meaningful role in the treatment of diabetic patients, this phenomenon was independent of the presence of diabetes.
Collapse
|
21
|
Laynez A, Sardi G, Hauville C, Barbash IM, Pakala R, Torguson R, Xue Z, Satler LF, Pichard AD, Waksman R. Safety and efficacy of everolimus-eluting stents versus paclitaxel-eluting stents in a diabetic population. Catheter Cardiovasc Interv 2012; 81:759-65. [PMID: 22488756 DOI: 10.1002/ccd.24438] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 03/01/2012] [Accepted: 03/27/2012] [Indexed: 11/05/2022]
Abstract
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. 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. 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. 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. 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.
Collapse
Affiliation(s)
- Ana Laynez
- Department of Cardiology, Washington Hospital Center, Washington, District of Columbia 20010, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Sawai T, Miyahara M, Nakajima H, Nakamori S, Sakai M, Tamada H, Tanigawa T, Yamada N, Nakamura M, Ito M. The impact of preprocedural hemoglobin A1c on the efficacy of sirolimus-eluting and paclitaxel-eluting stents. Cardiovasc Interv Ther 2012; 27:72-83. [PMID: 22623000 DOI: 10.1007/s12928-012-0095-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 12/21/2011] [Indexed: 11/26/2022]
Abstract
Several reports have shown contrary results regarding the efficacy of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in diabetic patients. The association between hemoglobin A1c (A1c) before coronary intervention and the midterm clinical outcomes of patients treated with these stents is unclear. The enrolled population was 415 patients with diabetes or impaired glucose tolerance (IGT) who underwent follow-up angiography after being implanted with a SES (n = 282) or PES (n = 133). The enrolled population was classified into the optimal glycemic control group (n = 213) and suboptimal glycemic control group (n = 202), and the predictors of restenosis were examined in each group. In the optimal glycemic control group, the use of PES was an independent predictor of restenosis [odds ratio (OR) 9.98, 95% confidence interval (CI) 3.08-38.9, p < 0.0001]; on the other hand, the use of SES was a positive independent predictor of restenosis prevention (OR 0.10, 95% CI 0.03-0.32, p < 0.0001). In the suboptimal glycemic control group, neither stent was predictive of restenosis. In a subanalysis, preprocedural A1c (≥7.0%) was found to be an independent predictor of restenosis in the SES group (OR 3.61, 95% CI 1.14-12.8, p = 0.03), but not the PES group. Postprocedural A1c (≥7.0%) was not an independent predictor of restenosis in either stent group. This study showed that the superiority of SES compared to PES was attenuated in the suboptimal glycemic control group. Preprocedural A1c (≥7.0%) was found to be an independent predictor of restenosis in the SES group, but not in the PES group.
Collapse
Affiliation(s)
- Toshiki Sawai
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Scheller B, Levenson B, Joner M, Zahn R, Klauss V, Naber C, Schächinger V, Elsässer A. Medikamente freisetzende Koronarstents und mit Medikamenten beschichtete Ballonkatheter. DER KARDIOLOGE 2011. [DOI: 10.1007/s12181-011-0375-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
24
|
2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011; 58:e44-122. [PMID: 22070834 DOI: 10.1016/j.jacc.2011.08.007] [Citation(s) in RCA: 1724] [Impact Index Per Article: 132.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
25
|
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:e574-651. [PMID: 22064601 DOI: 10.1161/cir.0b013e31823ba622] [Citation(s) in RCA: 901] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
26
|
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Jacobs AK, Anderson JL, Albert N, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Catheter Cardiovasc Interv 2011; 82:E266-355. [DOI: 10.1002/ccd.23390] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
27
|
Hillegass WB. Diabetes and percutaneous coronary intervention drug-eluting: stents whenever feasible. Catheter Cardiovasc Interv 2011; 78:718-9. [PMID: 22025471 DOI: 10.1002/ccd.23381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
28
|
Kufner S, de Waha A, Tomai F, Park SW, Lee SW, Lim DS, Kim MH, Galloe AM, Maeng M, Briguori C, Dibra A, Schömig A, Kastrati A. A meta-analysis of specifically designed randomized trials of sirolimus-eluting versus paclitaxel-eluting stents in diabetic patients with coronary artery disease. Am Heart J 2011; 162:740-7. [PMID: 21982668 DOI: 10.1016/j.ahj.2011.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 07/13/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is an ongoing debate on the optimal drug-eluting stent (DES) in diabetic patients with coronary artery disease. We addressed this issue by making a synthesis of the available evidence on the relative long-term efficacy and safety of sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) in these patients. METHODS Individual patient data were analyzed from 6 randomized trials specifically designed to compare SES with PES in diabetic patients. In total, 1183 patients were followed up for a median of 3.9 years (25th, 75th percentiles 3.4-4.5 years). The primary efficacy end point was target lesion revascularization (TLR). The composite of death and myocardial infarction (MI) was the primary safety end point. Stent thrombosis was a secondary end point. Overall hazard ratios (HRs) with 95% CIs were calculated as summary estimates. RESULTS No significant heterogeneity was seen across the 6 randomized trials for all analyzed events. Sirolimus-eluting stent was associated with a significant reduction in the risk of TLR (HR 0.65 [0.47-0.91], P = .01). No significant differences were observed regarding the risk of death or MI (HR 1.04 [0.74-1.45], P = .83) and stent thrombosis (HR 1.00 [0.31-3.30], P = .67). Mortality was also not affected by the type of DES (HR 0.95 [0.65-1.39], P = .79). CONCLUSIONS In diabetic patients with coronary artery disease, SES leads to a sustained reduction in the risk of TLR compared with PES. Both these DES types are, however, comparable with respect to the risk of stent thrombosis, MI, or death over long-term follow-up.
Collapse
|
29
|
Minha S, Bental T, Assali A, Vaknin-Assa H, Lev EI, Rechavia E, Battler A, Kornowski R. A comparative analysis of major clinical outcomes using drug-eluting stents versus bare metal stents in diabetic versus nondiabetic patients. Catheter Cardiovasc Interv 2011; 78:710-7. [DOI: 10.1002/ccd.23062] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 02/11/2011] [Accepted: 02/17/2011] [Indexed: 11/08/2022]
|
30
|
Stuckey TD, Brodie BR. Outcomes with drug-eluting stents in diabetic patients. Interv Cardiol 2011. [DOI: 10.2217/ica.11.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
31
|
Long-term (three-year) safety and efficacy of everolimus-eluting stents compared to paclitaxel-eluting stents (from the SPIRIT III Trial). Am J Cardiol 2011; 107:833-40. [PMID: 21247538 DOI: 10.1016/j.amjcard.2010.10.069] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 10/28/2010] [Accepted: 10/28/2010] [Indexed: 11/20/2022]
Abstract
The safety and efficacy of the XIENCE V everolimus-eluting stent (EES) compared to the Taxus Express(2) paclitaxel-eluting stent (PES) has been demonstrated through 2 years in the SPIRIT II and III randomized clinical trials, but limited longer-term data have been reported. In the SPIRIT III trial, 1,002 patients with up to 2 lesions in 2 coronary arteries were randomized 2:1 to EESs versus PESs at 65 United States sites. At completion of 3-year follow-up, treatment with EES compared to PES resulted in a significant 30% decrease in the primary clinical end point of target vessel failure (cardiac death, myocardial infarction, or ischemic-driven target vessel revascularization, 13.5% vs 19.2%, hazard ratio 0.70, 95% confidence interval 0.50 to 0.96, p = 0.03) and a 43% decrease in major adverse cardiovascular events, cardiac death, myocardial infarction, or ischemic-driven target lesion revascularization (9.1% vs 15.7%, hazard ratio 0.57, 95% confidence interval 0.39 to 0.83, p = 0.003). In a landmark analysis, major adverse cardiovascular events were decreased to a similar extent with EES compared to PES 0 through 1 year and 1 year through 3 years (hazard ratio 0.56, 95% confidence interval 0.35 to 0.90; hazard ratio 0.59, 95% confidence interval 0.31 to 1.11, respectively). In conclusion, patients treated with EES rather than PES in the SPIRIT III trial had significantly improved event-free survival at 3 years. From 1 year to 3 years hazard curves continued to diverge in favor of EES, consistent with an improving long-term safety and efficacy profile of EES compared to PES, with no evidence of late catchup.
Collapse
|
32
|
Lee SW, Park SW, Kim YH, Yun SC, Park DW, Lee CW, Kang SJ, Rhee KS, Chae JK, Ko JK, Park JH, Lee JH, Choi SW, Jeong JO, Seong IW, Cho YH, Lee NH, Kim JH, Chun KJ, Kim HS, Park SJ. A Randomized Comparison of Sirolimus- Versus Paclitaxel-Eluting Stent Implantation in Patients With Diabetes Mellitus. JACC Cardiovasc Interv 2011; 4:310-6. [DOI: 10.1016/j.jcin.2010.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/09/2010] [Indexed: 11/28/2022]
|
33
|
Higashitani M, Mori F, Yamada N, Arashi H, Kojika A, Hoshi H, Minami Y, Yamaguchi J, Yamauchi T, Takagi A, Ogawa H, Hagiwara N. Efficacy of paclitaxel-eluting stent implantation in hemodialysis patients. Heart Vessels 2011; 26:582-9. [DOI: 10.1007/s00380-010-0110-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 12/03/2010] [Indexed: 11/30/2022]
|
34
|
Park SJ. Sirolimus- versus paclitaxel-eluting stents for unselected patients with coronary artery disease. Catheter Cardiovasc Interv 2011; 77:13-4. [PMID: 21181967 DOI: 10.1002/ccd.22919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
35
|
Millauer N, Jüni P, Hofmann A, Wandel S, Bhambhani A, Billinger M, Urwyler N, Wenaweser P, Hellige G, Räber L, Cook S, Vogel R, Togni M, Seiler C, Meier B, Windecker S. Sirolimus versus paclitaxel coronary stents in clinical practice. Catheter Cardiovasc Interv 2010; 77:5-12. [DOI: 10.1002/ccd.22597] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
36
|
Hong SJ, Kim MH, Cha KS, Park HS, Chae SC, Hur SH, Gwon HC, Bae JH, Lim DS. Comparison of three-year clinical outcomes between sirolimus-versus paclitaxel-eluting stents in diabetic patients: Prospective randomized multicenter trial. Catheter Cardiovasc Interv 2010; 76:924-33. [DOI: 10.1002/ccd.22369] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
37
|
Akin I, Bufe A, Eckardt L, Reinecke H, Richardt G, Kuck KH, Senges J, Schneider S, Nienaber CA. Outcomes after differential use of drug-eluting stents in diabetic patients: 1-year results from the DES.DE (Drug-Eluting Stent.DEutschland) registry. Catheter Cardiovasc Interv 2010; 76:50-7. [PMID: 20578192 DOI: 10.1002/ccd.22450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The prospective multicenter German DES.DE registry provides real world data to evaluate the therapeutic principle of two different drug-eluting stents (DES) [Sirolimus- (SES) and Paclitaxel-eluting stent (PES)] in the context of the German Health System. BACKGROUND Differential DES have been effective in randomized trials, but their difference in safety and efficacy in diabetic patients has not been well studied. METHODS Baseline, predefined procedural as well as clinical in-hospital and follow-up events were recorded for all 1,526 diabetic patients. The composite of death, myocardial infarction (MI), and stroke defined as major adverse cardiac and cerebrovascular events (MACCE) and target vessel revascularization (TVR) were defined as primary endpoints. RESULTS Between October 2005 and October 2006, 1,526 diabetic patients, 34.2% of them being insulin-dependent, were enrolled (SES: n = 612; PES: n = 914) at 98 DES.DE sites. Overall, one third of patients were admitted with acute coronary syndrome (ACS) and 70% had multivessel-disease reflecting a real world scenario. With similar baseline clinical and descriptive morphology of coronary artery disease (CAD) in both DES groups, there were no statistical differences in 1-year follow-up with respect to rates of overall mortality (5.8% vs. 5.4%), TVR (12.0% vs. 11.3%), overall stent thrombosis (5.6% vs. 4.6%) and MACCE (11.4% vs. 10.3%) between both DES. CONCLUSION The data collected in DES.DE revealed no differences in clinical outcomes within 1 year between SES and PES in diabetic patients in a "real-world" setting.
Collapse
Affiliation(s)
- Ibrahim Akin
- Department of Cardiology, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Strasse 6, Rostock, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Hillegass WB. Drug-eluting or bare metal stents for diabetics: clinical judgment still wins. Catheter Cardiovasc Interv 2010; 76:482-3. [PMID: 20882648 DOI: 10.1002/ccd.22774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
MESH Headings
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/instrumentation
- Angioplasty, Balloon, Coronary/mortality
- Clinical Competence
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/mortality
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/mortality
- Drug-Eluting Stents
- Heart Diseases/complications
- Heart Diseases/mortality
- Heart Diseases/therapy
- Humans
- Judgment
- Metals
- Patient Selection
- Prosthesis Design
- Risk Assessment
- Risk Factors
- Stents
- Time Factors
- Treatment Outcome
Collapse
|
39
|
Cho Y, Yang HM, Park KW, Chung WY, Choi DJ, Seo WW, Jeong KT, Chae SC, Lee MY, Hur SH, Chae JK, Seong IW, Yoon JH, Oh SK, Kim DI, Park KS, Rha SW, Jang YS, Bae JH, Hong TJ, Cho MC, Kim YJ, Jeong MH, Kim MJ, Park SK, Chae IH, Kim HS. Paclitaxel- versus sirolimus-eluting stents for treatment of ST-segment elevation myocardial infarction: with analyses for diabetic and nondiabetic subpopulation. JACC Cardiovasc Interv 2010; 3:498-506. [PMID: 20488406 DOI: 10.1016/j.jcin.2010.02.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 02/05/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to determine which drug-eluting stent (DES) is preferable for the treatment of ST-segment elevation myocardial infarction (STEMI) and to elucidate the impact of diabetes mellitus on the outcome of each DES. BACKGROUND Recent studies have shown the benefit of DES in patients with STEMI. Diabetes mellitus might differentially affect outcomes of each DES. METHODS We analyzed the large-scale, prospective, observational KAMIR (Korea Acute Myocardial Infarction Registry) study, which enrolled 4,416 STEMI patients (26% with diabetes) treated with paclitaxel-eluting stent (PES) or sirolimus-eluting stent (SES). Primary outcome was major adverse cardiac event (MACE), defined as a composite of mortality, nonfatal myocardial infarction, and target lesion revascularization (TLR). RESULTS In the overall population, the MACE rate at 1 year was significantly higher in the PES than the SES group (11.6% vs. 8.6%, p = 0.014), which was mainly due to increased TLR (3.7% vs. 1.8%, p < 0.001). In the diabetic subgroup, however, the MACE rate was not significantly different between PES and SES (14.5% vs. 12.3%, p = 0.217), in contrast to the nondiabetic subgroup, where PES was inferior to SES as in the overall population. Matching by propensity-score did not significantly alter these results. For TLR, there was interaction between the type of stents and diabetes mellitus (unadjusted: p = 0.052; after propensity-score matching: p = 0.035). CONCLUSIONS The PES was inferior to the SES in the overall population, with regard to the occurrence of MACE and TLR. However, subgroup analysis for diabetic subjects showed no differences in clinical outcomes between PES and SES. These results suggest that diabetes differentially affects the outcome of first-generation DES.
Collapse
Affiliation(s)
- Youngjin Cho
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Sirolimus- Versus Paclitaxel-Eluting Stents for the Treatment of Coronary Bifurcations. J Am Coll Cardiol 2010; 55:1743-50. [DOI: 10.1016/j.jacc.2010.02.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 02/02/2010] [Accepted: 02/09/2010] [Indexed: 11/19/2022]
|
41
|
Akin I, Bufe A, Schneider S, Reinecke H, Eckardt L, Richardt G, Burska D, Senges J, Kuck KH, Nienaber CA. Clinical outcomes in diabetic and non-diabetic patients with drug-eluting stents: results from the first phase of the prospective multicenter German DES.DE registry. Clin Res Cardiol 2010; 99:393-400. [PMID: 20221833 DOI: 10.1007/s00392-010-0136-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Accepted: 02/15/2010] [Indexed: 01/02/2023]
Abstract
BACKGROUND Patients with diabetes mellitus (DM) undergoing coronary revascularization are at increased risk for adverse outcomes. Without sufficiently powered data from diabetic subgroup analyses and in absence of randomized controlled trials in diabetic patients with primary clinical outcomes controversy is ongoing over safety and efficacy of drug-eluting stents (DES) in diabetic patients. METHODS AND RESULTS Between October 2005 and October 2006, 1,659 diabetic and 3,559 non-diabetic patients treated with DES (Paclitaxel or Sirolimus-eluting stents) were enrolled at 98 Drug-Eluting-Stent.DEutschland (DES.DE) sites. Major adverse cardiac and cerebrovascular events (MACCE), defined as the composite of death, myocardial infarction, and stroke, as well as target vessel revascularization (TVR) were defined as primary endpoints. The baseline clinical and descriptive morphology of coronary artery disease revealed more severe findings in diabetic patients. At 1-year follow-up, diabetic patients treated with DES had significantly higher rates for overall death (5.6 vs. 3.4%; p < 0.01), myocardial infarction (4.8 vs. 3.4%; p = 0.05), stroke (1.7 vs. 0.9%; p < 0.05), MACCE (10.9 vs. 7.1%; p < 0.001), and overall stent thrombosis (4.9 vs. 3.3%; p < 0.01) with slightly elevated rates for TVR (12.0 vs. 10.4%; p = 0.17); data which remained after risk-adjustment. CONCLUSION Data collected in DES.DE revealed that despite the use of DES the risk of myocardial infarction, death, and thrombotic events remains higher in diabetic patients.
Collapse
Affiliation(s)
- Ibrahim Akin
- Divisions of Cardiology, Pulmonology, Department of Internal Medicine I, Intensive Care Unit, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Balducelli M, Ortolani P, Marzaroli P, Piovaccari G, Menozzi A, Manari A, Sangiorgio P, Tarantino F, Rossi R, Maresta A, Tondi S, Passerini F, Guastaroba P, Grilli R, Marzocchi A. Comparison of 2-year clinical outcomes with sirolimus and paclitaxel-eluting stents for patients with diabetes: results of the Registro Regionale AngiopLastiche Emilia-Romagna Registry. Catheter Cardiovasc Interv 2010; 75:327-34. [PMID: 19937776 DOI: 10.1002/ccd.22293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Long-term outcomes of percutaneous coronary interventions (PCI) with sirolimus-eluting stents (SES) compared to paclitaxel-eluting-stents (PES) in unselected diabetics in routine practice is still debated. OBJECTIVE This study compared the 2-year incidence of MACE (all-cause mortality, nonfatal myocardial infarction and target vessel revascularization) of SES and PES in a real-world setting of patients with diabetes. DESIGN Observational, multicenter, nonrandomized study. SETTING Prospective web-based registry (REAL Registry; study period, 2002-2005) comprising all 13 hospitals performing PCI. PATIENTS Among the 945 eligible patients treated with either SES alone (n = 606) or PES alone (n = 339), 29% were insulin-requiring, 72% had multivessel coronary disease, 26% had prior myocardial infarction and 10% had poor left ventricular function. MEASUREMENTS Unadjusted and propensity score-adjusted 2-year clinical outcome. RESULTS After propensity score adjustment, 2-year MACE incidence in the SES and PES groups was equivalent (23.3% vs. 23.7%, HR 1.01, 95%CI 0.72-1.42, P = 0.96). Adjusted 2-year angiographic stent thrombosis occurred in 1.1% of the SES patients versus 2.6% of the PES patients (P = 0.15). In this large, real-world, diabetic population treated with DES, there was no difference in outcome between SES and PES. Further studies are needed to demonstrate the long-term safety of different types of DES in patients with diabetes.
Collapse
Affiliation(s)
- Marco Balducelli
- Department of Cardiology, S. Maria delle Croci Hospital, Azienda Unitá Sanitaria Locale Ravenna, Viale Randi 5, Ravenna 48100, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Wolf WM, Vlachos HA, Marroquin OC, Lee JS, Smith C, Anderson WD, Schindler JT, Holper EM, Abbott JD, Williams DO, Laskey WK, Kip KE, Kelsey SF, Mulukutla SR. Paclitaxel-eluting versus sirolimus-eluting stents in diabetes mellitus: a report from the National Heart, Lung, and Blood Institute Dynamic Registry. Circ Cardiovasc Interv 2010; 3:42-9. [PMID: 20118153 DOI: 10.1161/circinterventions.109.885996] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diabetes is a powerful predictor of adverse events in patients undergoing percutaneous coronary intervention. Drug-eluting stents reduce restenosis rates compared with bare metal stents; however, controversy remains regarding which drug-eluting stents provides greater benefit in patients with diabetes. Accordingly, we compared the safety and efficacy of sirolimus-eluting stents (SES) with paclitaxel-eluting stents (PES) among diabetic patients in a contemporary registry. METHODS AND RESULTS Using the National Heart, Lung, and Blood Institute Dynamic Registry, we evaluated 2-year outcomes of diabetic patients undergoing percutaneous coronary interventions with SES (n=677) and PES (n=328). Clinical and demographic characteristics, including age, body mass index, insulin use, left ventricular function, and aspirin/clopidogrel use postprocedure, did not differ significantly between the groups except that PES-treated patients had a greater frequency of hypertension and hyperlipidemia. At the 2-year follow-up, no significant differences were observed between PES and SES with regard to safety or efficacy end points. PES- and SES-treated patients had similar rates of death (10.7% versus 8.2%, P=0.20), death and myocardial infarction (14.9% versus 13.6%, P=0.55), repeat revascularization (14.8% versus 17.8%, P=0.36), and stent thrombosis (1.3% versus 1.3%, P=0.95). After adjustment, no significant differences between the 2 stent types in any outcome were observed. CONCLUSIONS PES and SES are equally efficacious and have similar safety profiles in diabetic patients undergoing percutaneous coronary interventions in clinical practice.
Collapse
|
44
|
Zhang F, Dong L, Ge J. Meta-analysis of five randomized clinical trials comparing sirolimus- versus paclitaxel-eluting stents in patients with diabetes mellitus. Am J Cardiol 2010; 105:64-8. [PMID: 20102892 DOI: 10.1016/j.amjcard.2009.08.652] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 08/04/2009] [Accepted: 08/04/2009] [Indexed: 10/20/2022]
Abstract
Recent data on drug-eluting stents have shown improved clinical outcomes in patients with diabetes mellitus. However, the relative efficacy and safety of sirolimus-eluting stents (SES) compared with paclitaxel-eluting stents (PES) remains controversial. Therefore, a meta-analysis of randomized trials was performed to compare SES with PES exclusively in patients with diabetes. The published research was scanned by formal searches of electronic databases (PubMed, EMBASE and the Cochrane Central Register of Controlled Trials) from January 2001 to April 2009. All randomized trials involving head-to-head comparison of SES versus PES in patients with diabetes were examined for analysis. A total of 5 randomized trials were included in the present meta-analysis, involving 1,173 patients (594 in the SES group, 579 in the PES group). SES were significantly more effective in the reduction of target lesion revascularization (5.1% vs 11.4%, odds ratio [OR] 0.41, 95% confidence interval [CI] 0.26 to 0.64, p <0.001) and angiographic binary (> or =50%) restenosis (5.6% vs 16.4%, OR 0.30, 95% CI 0.19 to 0.48, p <0.001) compared to PES. In contrast, the differences between SES and PES were not statistically significant with respect to cardiac death (2.2% vs 2.9%, OR 0.71, 95% CI 0.34 to 1.47, p = 0.35), myocardial infarction (1.5% vs 2.6%, OR 0.58, 95% CI 0.26 to 1.31, p = 0.19), and stent thrombosis (0.6% vs 1.2%, OR 0.57, 95% CI 0.18 to 0.84, p = 0.35). In conclusion, SES are superior to PES in reducing the incidences of restenosis and target lesion revascularization in patients with diabetes, with nonsignificant differences in terms of cardiac death, myocardial infarction, and stent thrombosis.
Collapse
|
45
|
SPIRIT IV trial design: a large-scale randomized comparison of everolimus-eluting stents and paclitaxel-eluting stents in patients with coronary artery disease. Am Heart J 2009; 158:520-526.e2. [PMID: 19781409 DOI: 10.1016/j.ahj.2009.07.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 07/16/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the 300-patient SPIRIT II and 1002-patient SPIRIT III randomized trials, the everolimus-eluting stent (EES) compared to the paclitaxel-eluting stent (PES) resulted in reduced angiographic late loss (a primary end point in both trials), noninferior rates of 9-month target vessel failure (a primary end point in SPIRIT III), and reduced rates of target lesion revascularization and major adverse cardiac events (secondary end points). However, neither trial was powered for superiority for clinical end points, and the routine performance of angiographic follow-up may have artificially exaggerated the absolute benefits of EES. The relative efficacy of these 2 stents in patients with diabetes mellitus also remains controversial. We therefore designed a large-scale randomized trial without angiographic follow-up to further assess the differences between these 2 stent platforms. STUDY DESIGN SPIRIT IV is an ongoing prospective, active-controlled, single-blinded, multicenter clinical trial in which 3690 patients with native coronary artery disease have been randomized 2:1 to EES versus PES. Patients with up to 3 de novo native coronary artery lesions (maximum 2 lesions per epicardial vessel) with length <or=28 mm and reference vessel diameter >or=2.5 to <or=4.25 mm were enrolled at 66 US clinical sites. Clinical follow-up at 30, 180, and 270 days; 1 year; and then yearly for up to 5 years is underway. The primary end point is the rate of ischemia-driven target lesion failure at 1 year, a composite measure of safety and efficacy consisting of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization, with the trial powered for sequential noninferiority and superiority testing. SUMMARY SPIRIT IV is the largest randomized comparison of 2 DES with completed enrollment. The absence of routine angiographic follow-up will allow an accurate assessment of the absolute differences in the clinical safety and efficacy profile between these devices. The magnitude of the study will also permit significant insights to be gained into the relative performance of the 2 stents in important subgroups, including patients with diabetes mellitus.
Collapse
|
46
|
Lasala JM, Cox DA, Morris DL, Breall JA, Mahoney PD, Horwitz PA, Shaw D, Hood KL, Mandinov L, Dawkins KD. Two-year results of paclitaxel-eluting stents in patients with medically treated diabetes mellitus from the TAXUS ARRIVE program. Am J Cardiol 2009; 103:1663-71. [PMID: 19539073 DOI: 10.1016/j.amjcard.2009.02.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 02/05/2009] [Accepted: 02/05/2009] [Indexed: 10/20/2022]
Abstract
Drug-eluting stents decrease revascularization compared with bare metal stents in diabetic patients, but few studies have compared drug-eluting stent use in diabetic versus nondiabetic patients. The objective of this study was to assess whether paclitaxel provides equivalent revascularization decrease in diabetic and nondiabetic patients. The ARRIVE registries enrolled 7,492 patients receiving TAXUS Express stents, including 2,112 with medically treated diabetes; results were compared with those in the remaining 5,380 nondiabetic patients. Two-year target lesion revascularization (TLR) was comparable in diabetic and nondiabetic patients (8.2% vs 7.7%, p = 0.59) and remained similar after multivariate adjustment for baseline differences (7.1% vs 6.8%, p = 0.41). There were no significant TLR differences between diabetic and nondiabetic patients with small vessels (9.7% vs 9.5%, p = 0.96) or left main coronary artery, 3-vessel, or bifurcation stenting (10.7% vs 13.1%, p = 0.41). Diabetes was not a significant TLR predictor (hazard ratio 0.92, 95% confidence interval 0.77 to 1.12, p = 0.41). Stent thrombosis (2.6% vs 2.4%, p = 0.55) and myocardial infarction (3.8% vs 3.0%, p = 0.09) rates were also similar for diabetic and nondiabetic patients. However, 2-year mortality was significantly increased in diabetic compared with nondiabetic patients (9.7% vs 5.3%, p <0.001). Increased mortality drove significantly increased major cardiac events in diabetics; however, there was no difference in stent-related major cardiac events (8.9% vs 10.1%, p = 0.13). In conclusion, these results suggest that TAXUS paclitaxel-eluting stents abrogate the increased diabetic risk of clinical restenosis previously reported with bare metal stents, with similar low risk of myocardial infarction or stent thrombosis for diabetic and nondiabetic patients. However, diabetic patients still have increased risk of 2-year mortality.
Collapse
|
47
|
Dixon SR, Grines CL, O'Neill WW. The Year in Interventional Cardiology. J Am Coll Cardiol 2009; 53:2080-97. [DOI: 10.1016/j.jacc.2009.02.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Accepted: 02/18/2009] [Indexed: 12/19/2022]
|
48
|
Fröbert O, Lagerqvist B, Carlsson J, Lindbäck J, Stenestrand U, James SK. Differences in Restenosis Rate With Different Drug-Eluting Stents in Patients With and Without Diabetes Mellitus. J Am Coll Cardiol 2009; 53:1660-7. [PMID: 19406341 DOI: 10.1016/j.jacc.2009.01.054] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 01/22/2009] [Accepted: 01/27/2009] [Indexed: 10/20/2022]
|
49
|
POP ANDREI, GRINES CINDYL. Choice of DES: A US Clinician's Perspective. J Interv Cardiol 2009. [DOI: 10.1111/j.1540-8183.2009.00453.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
50
|
Mayor M, Malik AZ, Minor RJ, Deshpande MC, Strauss WE, Maloney TH, Baim DS, O'Neill W, Kandzari DE. One-year outcomes from the TAXUS express stent versus cypher stent. Am J Cardiol 2009; 103:930-6. [PMID: 19327418 DOI: 10.1016/j.amjcard.2008.11.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 11/21/2008] [Accepted: 11/21/2008] [Indexed: 10/21/2022]
Abstract
We compared 1-year outcomes in patients treated with paclitaxel-eluting stents (PESs) or sirolimus-eluting stents (SESs) in "real-world" clinical practice. Clinical outcomes were evaluated in 1,558 consecutive, unselected, retrospectively collected patients treated with drug-eluting stents (DESs; PES = 816, SES = 742) at 19 United States centers. The primary end point was 1-year target vessel revascularization (TVR). The study included a prespecified diabetic cohort (PES = 289, SES = 247), for which efficacy comparisons between DESs were analyzed according to vessel diameter and presence of chronic kidney disease. Baseline demographic, angiographic, and procedural characteristics were similar between patients treated with PESs and those treated with SESs. At 1 year, there were no overall statistical differences in death, myocardial infarction, TVR, or stent thrombosis. In the diabetic cohort, however, the cumulative incidence of TVR was significantly lower for patients treated with PESs (3%) compared with SESs (9%, p <0.01), which persisted after adjustment for baseline differences (hazard ratio 0.29, 95% confidence interval 0.12 to 0.67). This decrease in TVR with PES was similar in insulin- and noninsulin-requiring diabetic patients. In multivariate analysis, independent predictors of TVR included diabetes, bifurcation stenting, and overlapping stents; in the diabetic cohort, treatment with SESs was also a multivariate predictor of TVR. In conclusion, in this observational, retrospective analysis of DES-treated patients, PESs and SESs demonstrated similar overall safety and efficacy, but PESs were associated with a significant decrease in 1-year TVR rates in diabetic patients.
Collapse
|