Abstract

OBJECTIVE. It is still controversial whether sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) are equally effective in patients with diabetes mellitus. In these patients, multiple individual variables may be responsible for neointimal hyperplasia, thus making difficult the comparison of the two drug-eluting stents (DES).

RESEARCH DESIGN AND METHODS. We designed a prospective, randomized study in order to compare the efficacy in the prevention of restenosis of SES and PES, both implanted in the same diabetic patient with multiple de novo coronary artery lesions undergoing elective percutaneous coronary intervention. We enrolled 60 patients with diabetes mellitus with at least two significant de novo angiographic stenoses in different coronary segments. The primary end point was in-stent late luminal loss (LLL) at 8-month angiographic follow-up.

RESULTS. One-hundred-twenty lesions were successfully treated with the randomly assigned DES (either SES n=60 or PES n=60). In-stent LLL was lower in the SES than in the PES group (0.26±0.4 vs 0.50±0.6 mm; P=0.01). Coronary lesions treated with SES presented a reduced in-stent LLL in 40 (68%) patients, while PES resulted in a lower in-stent LLL in 19 (32%) patients (P=0.0002). At multivariable analysis, the type of DES implanted was the only independent predictor of in-stent LLL (OR 2.3; 95% CI 1.1-5.0; P=0.03).

CONCLUSIONS. SES directly compared to PES in the same diabetic patient is associated with a decrease in the extent of in-stent LLL at 8 months, suggesting a reduced risk of restenosis.