Differential long-term outcomes of zotarolimus-eluting stents compared with sirolimus-eluting and paclitaxel-eluting stents in diabetic and non-diabetic patients: 2-year subgroup analysis of the ZEST randomized trial.
Summary of "Differential long-term outcomes of zotarolimus-eluting stents compared with sirolimus-eluting and paclitaxel-eluting stents in diabetic and non-diabetic patients: 2-year subgroup analysis of the ZEST randomized trial."
OBJECTIVES:
To evaluate the differential treatment effects of zotarolimus-eluting stents (ZES), sirolimus-eluting stents (SES), and paclitaxel-eluting stents (PES) according to diabetic status.
BACKGROUND:
Diabetic patients have a higher risk of ischemic complications after stenting than non-diabetic patients.
METHODS:
Using data from the ZEST randomized trial, comparing ZES with SES and PES, we evaluated relative outcomes among stents in diabetic and non-diabetic patients. The primary outcome was a major adverse cardiac event (MACE), defined as a composite of death, myocardial infarction, or ischemia-driven target-vessel revascularization.
RESULTS:
Of the 2,645 patients enrolled in the ZEST trial, 760 (29%) had diabetes mellitus. Baseline clinical and angiographic characteristics were similar in the 3 stent groups, regardless of diabetic status. In diabetic patients, ZES showed similar rates of MACE compared to PES (13.8% vs. 15.3%, P=0.58), but higher rates of MACE than SES (13.8% vs. 7.7%, P=0.05). In non-diabetic patients, ZES showed similar rates of MACE compared to SES (10.3% vs.10.8%, P=0.72), whereas significantly lower rates of MACE compared to PES (10.3% vs. 15.3%, P=0.01). In comparing the ZES and SES groups, there was a substantial interaction between diabetic status and stent types on MACE occurrence (Interaction P=0.07). However, in comparison of ZES and PES, there were no significant interactions between diabetes and stent type on MACE (Interaction P=0.25).
CONCLUSIONS:
In diabetic patients, SES showed the lowest rate of MACE compared with ZES and PES. But, in non-diabetic patients, SES and ZES showed significantly lower rates of MACE than PES. ZES shows a diabetes-related interaction on MACE compared with SES, but not with PES. © 2012 Wiley Periodicals, Inc.
Affiliation
Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Journal Details
This article was published in the following journal.
Name: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22899589
- DOI: http://dx.doi.org/10.1002/ccd.24603
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