Editor’s Choice Differential Long-Term Outcomes of Zotarolimus- Eluting Stents Compared With Sirolimus-Eluting and Paclitaxel-Eluting Stents in Diabetic and Nondiabetic Patients: Two-Year Subgroup Analysis of the ZEST Randomized Trial Sun-Joo Jang, 1 MD, Duk-Woo Park, 1 MD, Won-Jang Kim, 1 MD, Young-Hak Kim, 1 MD, Sung-Cheol Yun, 2 PhD, Soo-Jin Kang, 1 MD, Seung-Whan Lee, 1 MD, Cheol Whan Lee, 1 MD, Seong-Wook Park, 1 MD, and Seung-Jung Park, 1 * MD Objectives: To evaluate the differential treatment effects of zotarolimus-eluting stents (ZES), sirolimus-eluting stents (SES), and paclitaxel-eluting stents (PES) according to diabetic status. Background: Diabetic patients have a higher risk of ischemic compli- cations after stenting than nondiabetic patients. Methods: Using data from the ZEST randomized trial, comparing ZES with SES and PES, we evaluated relative outcomes among stents in diabetic and nondiabetic patients. The primary outcome was a major adverse cardiac event (MACE), defined as a composite of death, myocardial infarction, or ischemia-driven target-vessel revascularization. Results: Of the 2,645 patients en- rolled in the ZEST trial, 760 (29%) had diabetes mellitus. Baseline clinical and angio- graphic characteristics were similar in the three stent groups, regardless of diabetic status. In diabetic patients, ZES showed similar rates of MACE as compared to PES (13.8% vs. 15.3%, P 5 0.58), but higher rates of MACE than SES (13.8% vs. 7.7%, P 5 0.05). In nondiabetic patients, ZES showed similar rates of MACE as compared to SES (10.3% vs. 10.8%, P 5 0.72), whereas significantly lower rates of MACE compared to PES (10.3% vs. 15.3%, P 5 0.01). In comparing the ZES and SES groups, there was a substantial interaction between diabetic status and stent types on MACE occurrence (Interaction P 5 0.07). However, in comparison of ZES and PES, there were no signifi- cant interactions between diabetes and stent type on MACE (Interaction P 5 0.25). Conclusions: In diabetic patients, SES showed the lowest rate of MACE compared with ZES and PES. But, in nondiabetic patients, SES and ZES showed significantly lower rates of MACE than PES. ZES shows a diabetes-related interaction on MACE compared with SES, but not with PES. V C 2012 Wiley Periodicals, Inc. Key words: percutaneous coronary intervention; coronary artery disease; diabetes 1 Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea 2 Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea Conflict of interest: Nothing to report. Grant sponsors: the CardioVascular Research Foundation, Seoul, Korea and Medtronic Vascular, Santa Rosa, California. *Correspondence to: Seung-Jung Park, Department of Cardiology, University of Ulsan College of Medicine, Cardiac Center, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-gu, Seoul 138-736, Korea. E-mail: sjpark@amc.seoul.kr Received 1 March 2012; Revision accepted 9 August 2012 DOI 10.1002/ccd.24603 Published online 17 August 2012 in Wiley Online Library (wileyonlinelibrary.com) V C 2012 Wiley Periodicals, Inc. Catheterization and Cardiovascular Interventions 81:1106–1114 (2013)