Risk Factors for Stent Thrombosis After Implantation of Sirolimus-Eluting Stents in Diabetic and Nondiabetic PatientsThe EVASTENT Matched-Cohort Registry
Jacques Machecourt, MD, FESC*,
Nicolas Danchin, MD, FESC ,*,
Jean Marc Lablanche, MD, FESC ,
Jean Marie Fauvel, MD, FESC ,
Jean Louis Bonnet, MD, FESC||,
Stephanie Marliere, MD*,
Alison Foote, PhD¶,
Jean Louis Quesada¶,
Hélène Eltchaninoff, MD, FESC#,
Gérald Vanzetto, MD, PhD* for the EVASTENT Investigators
* CHU Michallon, Grenoble, France
Hôpital Européen Georges Pompidou, Paris, France
Hôpital Cardiologique, CHU Lille, Lille, France
Hôpital Cardiologique, CHU Toulouse, Toulouse, France
|| CHU La Timone, Marseille, France
¶ INSERM Clinical Research Center, Grenoble, France
# CHU Charles Nicolle, Rouen, France
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Figure 1 MACE-Free Survival
Major adverse cardiac event (MACE)-free survival rates in the 4 prespecified groups of patients according to the presence of diabetes and the number of diseased vessels. The multivessel disease (MVD) diabetic patients experienced a more severe MACE-free survival curve than the other groups, and single-vessel disease (SVD) nondiabetic patients survived better, whereas SVD diabetic patients and MVD nondiabetic patients experienced similar survival curves. The MACE rate was defined as a composite of occurrence of cardiovascular death, acute myocardial infarction, and stent thrombosis (by any Academic Research Consortium definition).
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Figure 2 Event-Free Survival in Diabetic and Nondiabetic Patients
Comparison of the event-free survival curves between diabetic and nondiabetic patients. (A) Global mortality; (B) stent thrombosis (ST); (C) target lesion revascularization (TLR); (D) target vessel failure (TVF). A TVF was defined as a composite of occurrence of cardiovascular death, ST, and target vessel revascularization. These survival curves were more severe in diabetic patients.
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Figure 3 Occurrence of Stent Thrombosis
Cumulative curve of occurrence of subacute (SAT) or late acute (LAST) stent thrombosis (ST) (by any Academic Research Consortium definition). Of note is the surge of the actuarial curve between day 90 and day 180, when the dual antiplatelet therapy was shifted to a single antithrombotic therapy for most of the patients. 1 = SAT; 2 = LAST; 3 = very LAST.
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Figure 4 Event Rate in Diabetics With or Without Insulin Therapy
Comparison of event rates between insulin-requiring diabetic patients (327 patients, 39%) and noninsulin treated diabetic patients (517 patients, 61%): mortality, ST, TLR, target vessel revascularization (TVR), and non-TVR rates were significantly higher in insulin-treated diabetic patients. DM = diabetes mellitus; other abbreviations as in Figure 2.
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