CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Differences in Restenosis Rate With Different Drug-Eluting Stents in Patients With and Without Diabetes MellitusA Report From the SCAAR (Swedish Angiography and Angioplasty Registry)
Ole Fröbert, MD, PhD*,*,
Bo Lagerqvist, MD, PhD ,
Jörg Carlsson, MD, PhD ,
Johan Lindbäck, MS ,
Ulf Stenestrand, MD, PhD|| and
Stefan K. James, MD, PhD
* Department of Cardiology, Örebro University Hospital, Örebro, Sweden
Department of Cardiology, Uppsala University Hospital Uppsala, Uppsala, Sweden
Department of Medicine, Kalmar Hospital, Kalmar, Sweden
UCR, Uppsala Clinical Research Center, Uppsala, Sweden
|| Department of Cardiology, Linköping University Hospital, Linköping, Sweden
Manuscript received September 23, 2008;
revised manuscript received January 22, 2009,
accepted January 27, 2009.
* Reprint requests and correspondence: Dr. Ole Fröbert, Department of Cardiology, Örebro University Hospital, Södra Grev Rosengatan, 701 85 Örebro, Sweden (Email: ole.frobert{at}orebroll.se).
Objectives: Our aim was to evaluate restenosis rate of drug-eluting stents (DES) in patients with and without diabetes mellitus (DM) in a real-world setting.
Background: DES seem less effective in patients with DM.
Methods: The SCAAR (Swedish Coronary Angiography and Angioplasty Registry) includes all patients undergoing percutaneous coronary intervention in Sweden. From April 1, 2004, to April 20, 2008, all restenoses detected at a subsequent angiography and all DES types implanted at more than 500 occasions were assessed using Cox regression.
Results: Four DES types qualified for inclusion. In total, 35,478 DES were implanted at 22,962 procedures in 19,004 patients and 1,807 restenoses were reported over a mean 29 months follow-up. In the entire population, the restenosis rate per stent was 3.5% after 1 year and 4.9% after 2 years. The adjusted risk of restenosis was higher in patients with DM compared with that in patients without DM (relative risk [RR]: 1.23, 95% confidence interval [CI]: 1.10 to 1.37). In patients with DM, restenosis was twice as frequent with the zotarolimus-eluting Endeavor stent (Medtronic, Minneapolis, Minnesota) compared with that in the other DES types. The Endeavor stent and the sirolimus-eluting Cypher stent (Cordis, Johnson & Johnson, Miami, Florida) had higher restenosis rates in patients with DM compared with those in patients without DM (RR: 1.77, 95% CI: 1.29 to 2.43 and RR: 1.25, 95% CI: 1.04 to 1.51). Restenosis rate with the paclitaxel-eluting Taxus Express and Liberté (Boston Scientific, Natick, Massachusetts) stents was unrelated to DM. Mortality did not differ between different DES.
Conclusions: Restenosis rate with DES was higher in patients with DM compared with that in patients without DM. There seem to be important differences between different brands of DES.
Key Words: angioplasty • coronary artery disease • diabetes mellitus • drug-eluting stents
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Abbreviations and Acronyms
| | BMS = bare-metal stent(s) | | CI = confidence interval | | DES = drug-eluting stent(s) | | DM = diabetes mellitus | | PCI = percutaneous coronary intervention | | RR = relative risk |
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