Paclitaxel-versus sirolimus-eluting stents for treatment of ST-segment elevation myocardial infarction: With analyses for diabetic and nondiabetic subpopulation

Youngjin Cho, Han Mo Yang, Kyung Woo Park, Woo Young Chung, Dong Joo Choi, Won Woo Seo, Kyoung Tae Jeong, Sung Chul Chae, Myoung Yong Lee, Seung Ho Hur, Jei Keon Chae, In Whan Seong, Jung Han Yoon, Suk Kyu Oh, Doo Il Kim, Keum Soo Park, Seung-Woon Rha, Yang Soo Jang, Jang Ho Bae, Taeg Jong HongMyeong Chan Cho, Young Jo Kim, Myung Ho Jeong, Min Jung Kim, Sue K. Park, In Ho Chae, Hyo Soo Kim

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22 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)498-506
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume3
Issue number5
DOIs
Publication statusPublished - 2010 May 1

Keywords

  • diabetes mellitus
  • myocardial infarction
  • stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

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    Cho, Y., Yang, H. M., Park, K. W., Chung, W. Y., Choi, D. J., Seo, W. W., Jeong, K. T., Chae, S. C., Lee, M. Y., Hur, S. H., Chae, J. K., Seong, I. W., Yoon, J. H., Oh, S. K., Kim, D. I., Park, K. S., Rha, S-W., Jang, Y. S., Bae, J. H., ... Kim, H. S. (2010). Paclitaxel-versus sirolimus-eluting stents for treatment of ST-segment elevation myocardial infarction: With analyses for diabetic and nondiabetic subpopulation. JACC: Cardiovascular Interventions, 3(5), 498-506. https://doi.org/10.1016/j.jcin.2010.02.011