Sirolimus-Eluting Stents Versus Paclitaxel-Eluting Stents in the Treatment of Coronary Artery Disease in Patients With Diabetes Mellitus Pramod K. Kuchulakanti, MD, William W. Chu, MD, PhD, Rebecca Torguson, BS, Leonardo Clavijo, MD, Roswitha Wolfram, MD, Sundeep Mishra, MD, Zhenyi Xue, MS, Natalie Gevorkian, MD, William O. Suddath, MD, Lowell F. Satler, MD, Kenneth M. Kent, MD, Augusto D. Pichard, MD, and Ron Waksman, MD* This study was performed to compare the safety and efficacy of sirolimus-eluting stents (SESs) and paclitaxel-eluting stents (PESs) on the outcomes of diabetic patients. Recent data with drug-eluting stents have shown improved clinical outcomes in diabetic patients. This study compared outcomes between the 2 available drug-eluting stents, SESs and PESs. From the prospective drug-eluting stent registries at the investigators’ institution, 1,320 consecutive diabetic patients treated with SESs (n  873, 1,293 lesions) and PESs (n  447, 733 lesions) were identified and their in-hospital and 1- and 6-month clinical outcomes compared. Baseline characteristics showed more men, more patients with previous coro- nary bypass surgery, and smaller ejection fractions in the PES group and more obese patients in the SES group. Procedural characteristics were similar except for more left anterior descending artery and proximal lesions and the greater use of glycoprotein IIb/IIIa inhibitors in the SES group and more type C lesions, direct stenting, and stents per patient in the PES group. In-hospital complications were similar. Clinical follow-up at 1 month was also similar between the 2 groups, including subacute stent thrombosis. At 6 months, the 2 groups had similar mortality (7% vs 7%), myocardial infarctions (18% vs 21%), target lesion revascularization, target vessel revascularization, major adverse cardiac events (11% vs 12%), and late thrombosis (0.3% vs 0%). Subanalysis of insulin-treated diabetic patients showed no significant differences in outcomes in the 2 groups. No significant differences were found between SESs and PESs on Cox regression analysis for hazard ratios. In conclusion, SESs and PESs are associated with similar efficacy and safety with regard to repeat revascularization rates, major adverse cardiac events, and stent thrombosis up to 6 months for the treatment of coronary artery disease in patients with diabetes mellitus regardless of insulin therapy. © 2006 Elsevier Inc. All rights reserved. (Am J Cardiol 2006;98:187–192) Diabetes mellitus (DM), 1 of the major risk factors for coronary artery disease, portends adverse prognoses in pa- tients regardless of revascularization strategy. 1–4 Coronary stent implantation, compared with balloon angioplasty, has improved the clinical outcomes of diabetic patients, primarily as a result of reductions in acute complications and restenosis rates. 5–9 Drug-eluting stents have shown the ability to reduce angiographic restenosis and major ad- verse cardiac event rates in de novo coronary lesions in a broad range of patients. 10,11 Subanalyses of experiences with 2 approved drug-eluting stents, sirolimus-eluting stents (SESs) and paclitaxel-eluting stents (PESs), in a subset of diabetic patients have demonstrated reductions in restenosis and revascularization. 12–14 Whether the 2 types of stent are similar in efficacy and safety profiles is not yet known. The purpose of the present study was to compare the safety and efficacy of SESs and PESs in a diabetic patient population. Methods From the prospective Cypher Registry Experience at the Washington Hospital Center With Drug-Eluting Stents and Taxus Registry Experience at the Washington Hospital Cen- ter With Drug-Eluting Stents at our institution, we identified 1,320 consecutive diabetic patients treated with either SESs (Cypher, Cordis Corporation, Warren, New Jersey; n = 873, 1,293 lesions) or PESs (Taxus, Boston Scientific Corpora- tion, Natick, Massachusetts; n = 447, 733 lesions) since April 2003. Patients were considered to have DM if they were receiving insulin or oral hypoglycemic drugs at the time of percutaneous coronary intervention. The percent- ages of patients with insulin-dependent DM were 31% in each group (274 in the SES group and 141 in the PES group). Contemporary percutaneous coronary intervention was performed after obtaining written informed consent. At the Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, District of Columbia. Manuscript received October 4, 2005; revised manuscript received and accepted January 31, 2006. * Corresponding author: Tel: 202-877-2812; fax: 202-877-2715. E-mail address: ron.waksman@medstar.net (R. Waksman). 0002-9149/06/$ – see front matter © 2006 Elsevier Inc. All rights reserved. www.AJConline.org doi:10.1016/j.amjcard.2006.01.074