Published online before print March 5, 2009, doi: 10.1161/CIRCOUTCOMES.108.826057
Original Articles |
Paclitaxel Versus Sirolimus Stents in Diabetic and Nondiabetic Patients
From the Institute for Clinical Evaluative Sciences (M.C., D.T.K., P.C.A., J.V.T.); the Institute of Medical Science (M.C., J.V.T.), and the Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto (D.T.K., E.A.C., J.V.T.), Toronto, Canada; and St. Joseph’s Healthcare and Programs for Assessment of Technology in Health (PATH) Research Institute (R.G., G.B.) and the Hamilton Health Sciences, McMaster University (J.L.V.), Hamilton, Canada.
Correspondence to Jack V. Tu, MD, PhD, Institute for Clinical Evaluative Sciences G106-2075 Bayview Ave, Toronto, ON M4N 3M5, Canada. E-mail tu{at}ices.on.ca
Received October 8, 2008; accepted January 13, 2009.
Background— Drug-eluting stents are more effective in reducing restenosis than bare-metal stents. Less certain is the relative performance of 2 widely used drug-eluting stents—sirolimus- and paclitaxel-eluting stents—in diabetic and nondiabetic patients undergoing percutaneous coronary intervention in routine clinical practice. We therefore studied the long-term effectiveness and safety of sirolimus versus paclitaxel stents overall and stratified by the absence or presence of diabetes.
Methods and Results— We compared sirolimus and paclitaxel stents in a propensity-score matched cohort of 2054 pairs of patients (835 matched pairs of diabetic patients and 1219 matched pairs of nondiabetic patients) undergoing percutaneous coronary intervention in Ontario between December 1, 2003 and March 31, 2006. The cohort was derived from the Cardiac Care Network of Ontario percutaneous coronary intervention registry and linked to population-based administrative health databases. In the overall cohort, there was no difference in rates of target-vessel revascularization (P=0.47), myocardial infarction (P=0.71), or death (P=0.49). As compared with paclitaxel stents, the use of sirolimus stents was associated with a significantly lower 3-year rate of target-vessel revascularization in nondiabetic patients (8.3% versus 10.0%, P=0.01), but not in diabetic patients (12.7% versus 10.3%, P=0.07). Rates of all-cause mortality were similar in patients receiving sirolimus stents versus paclitaxel stents in both the diabetic (8.4% versus 9.2%, P=0.91) and nondiabetic (4.6% versus 3.0%, P=0.22) groups.
Conclusions— In this large observational study, patients receiving paclitaxel and sirolimus stents had similar mortality rates, but nondiabetic patients receiving sirolimus stents were significantly less likely to require repeat revascularization.
Key Words: coronary disease • diabetes mellitus • revascularization • stents • real-world outcomes
CLINICAL PERSPECTIVE
The online-only Data Supplement is available at http://circoutcomes.ahajournals.org/cgi/content/full/CIRCOUTCOMES.108.811109/DC1.
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