Yang Yujin, Hyun Junho, Lee Junghoon, Kim Ju Hyeon, Lee Jeong Bok, Kang Do-Yoon, Lee Pil Hyung, Ahn Jung-Min, Park Duk-Woo, Park Seung-Jung
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Division of Clinical Epidemiology and Biostatistics, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
JACC Asia. 2021 Sep 21;1(2):173-184. doi: 10.1016/j.jacasi.2021.07.009. eCollection 2021 Sep.
Diabetes mellitus (DM) is a well-known risk factor for adverse cardiovascular events in patients receiving percutaneous coronary intervention (PCI). Limited data are available on the relative performance of different types of contemporary drug-eluting stents (DES) for diabetic patients.
The authors investigated the effectiveness and safety profiles of several contemporary DES in patients with DM in a "real-world" clinical setting.
Among 24,516 patients enrolled in a multicenter, prospective registry, 7,823 patients with DM were treated with 4 contemporary DES: 2,877 with a cobalt chromium everolimus-eluting stent (EES), 789 with a biodegradable polymer biolimus-eluting stent, 2,286 with a platinum chromium-EES, and 1,871 with a Resolute zotarolimus-eluting stent. The primary outcome was target vessel failure (TVF) (a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization).
The median follow-up duration was 2.9 years. Observed 3-year rates of TVF were not significantly different according to different DES types. On multigroup propensity-score analysis, the adjusted HRs for TVF were similar in between-group comparisons: biodegradable polymer biolimus-eluting stent (HR: 0.94; 95% CI: 0.76-1.16; = 0.57), platinum chromium-EES (HR: 0.94; 95% CI: 0.81-1.09; = 0.41), and Resolute zotarolimus-eluting stent (HR: 1.01; 95% CI: 0.86-1.18; = 0.93) compared with the cobalt chromium-EES (reference). This trend was maintained in patients with non-insulin- and insulin-treated DM.
In this multicenter clinical-practice PCI registry, no significant between-group differences were found for a 3-year risk of TVF in patients with DM undergoing PCI with various types of contemporary DES. (Evaluation of the First, Second, and New Drug-Eluting Stents in Routine Clinical Practice [IRIS-DES]; NCT01186133).
糖尿病（DM）是接受经皮冠状动脉介入治疗（PCI）患者发生不良心血管事件的一个众所周知的危险因素。关于不同类型当代药物洗脱支架（DES）在糖尿病患者中的相对性能的数据有限。
作者在“真实世界”临床环境中研究了几种当代DES在糖尿病患者中的有效性和安全性。
在一项多中心前瞻性注册研究纳入的24516例患者中，7823例糖尿病患者接受了4种当代DES治疗：2877例使用钴铬依维莫司洗脱支架（EES），789例使用可生物降解聚合物生物雷帕霉素洗脱支架，2286例使用铂铬-EES，1871例使用雷帕霉素洗脱支架。主要结局是靶血管失败（TVF）（心脏死亡、靶血管心肌梗死和靶血管血运重建的复合终点）。
中位随访时间为2.9年。根据不同DES类型观察到的3年TVF发生率无显著差异。在多组倾向评分分析中，组间比较时TVF的调整后风险比相似：与钴铬-EES（对照）相比，可生物降解聚合物生物雷帕霉素洗脱支架（风险比：0.94；95%置信区间：0.76-1.16；P=0.57）、铂铬-EES（风险比：0.94；95%置信区间：0.81-1.09；P=0.41）和雷帕霉素洗脱支架（风险比：1.01；95%置信区间：0.86-1.18；P=0.93）。在非胰岛素治疗和胰岛素治疗的糖尿病患者中也保持了这一趋势。
在这项多中心临床实践PCI注册研究中，接受各种当代DES进行PCI的糖尿病患者3年TVF风险在组间未发现显著差异。（常规临床实践中第一代、第二代和新型药物洗脱支架的评估[IRIS-DES]；NCT01186133）
