Effects of stent generation on clinical outcomes after acute myocardial infarction compared between prediabetes and diabetes patients

Abstract

We investigated the effects of stent generation on 2-year clinical outcomes between prediabetes and diabetes patients after acute myocardial infarction (AMI). A total of 13,895 AMI patients were classified into normoglycemia (group A: 3673), prediabetes (group B: 5205), and diabetes (group C: 5017). Thereafter, all three groups were further divided into first-generation (1G)-drug-eluting stent (DES) and second-generation (2G)-DES groups. Patient-oriented composite outcomes (POCOs) defined as all-cause death, recurrent myocardial infarction (Re-MI), and any repeat revascularization were the primary outcome. Stent thrombosis (ST) was the secondary outcome. In both prediabetes and diabetes groups, the cumulative incidences of POCOs, any repeat revascularization, and ST were higher in the 1G-DES than that in the 2G-DES. In the diabetes group, all-cause death and cardiac death rates were higher in the 1G-DES than that in the 2G-DES. In both stent generations, the cumulative incidence of POCOs was similar between the prediabetes and diabetes groups. However, in the 2G-DES group, the cumulative incidences of Re-MI and all-cause death or MI were significantly higher in the diabetes group than that in the prediabetes group. To conclude, 2G-DES was more effective than 1G-DES in reducing the primary and secondary outcomes for both prediabetes and diabetes groups.

Comparison of Clinical Outcomes after Non-ST-Segment and ST-Segment Elevation Myocardial Infarction in Diabetic and Nondiabetic Populations

“…Because recent reports concerning long-term clinical outcomes in patients with and without DM are confined to patients with NSTEMI [ 12 ] or STEMI [ 13 ], data on head-to-head comparisons between long-term clinical outcomes in NSTEMI and STEMI in patients with and without DM are scarce. Currently, new-generation drug-eluting stents (DESs) have nearly replaced bare-metal stents (BMSs) and first-generation DESs (1G-DESs) for routine percutaneous coronary intervention (PCI) [ 14 ]. New-generation DESs are more effective than 1G-DESs in reducing major clinical outcomes in patients with DM [ 14 ].…”

“…Currently, new-generation drug-eluting stents (DESs) have nearly replaced bare-metal stents (BMSs) and first-generation DESs (1G-DESs) for routine percutaneous coronary intervention (PCI) [ 14 ]. New-generation DESs are more effective than 1G-DESs in reducing major clinical outcomes in patients with DM [ 14 ]. Furthermore, to the best of our knowledge, no specific large-scale study has compared the long-term clinical outcomes between the NSTEMI and STEMI groups in patients with and without DM after PCI using new-generation DESs to reflect current real-world practice.…”

Comparison of 3-Year Outcomes between Early and Delayed Invasive Strategies in Older and Younger Adults with Non-ST-Segment Elevation Myocardial Infarction Undergoing New-Generation Drug-Eluting Stent Implantation

“…Although DESs are carefully designed to reduce ST, the risk of late ST and restenosis is seen with DES use in clinical trials [ 7 , 32 ]. The introduction of the 1G-DES (Cypher and Taxus) revolutionized the field of interventional cardiology, but second-generation DESs (2G-DES; Xience, Promus) are the gold standard of stent technology because they not only resolved the problems associated with 1G-DES (such as inflammation and restenosis) but also decreased the mortality rate [ 33 ].…”

Diabetes and restenosis

“…A more recent retrospective study stratified 13,895 patients with prior MI into normoglycemic, pre-diabetic, and diabetic groups to compare outcomes between first and second-generation DES intervention. The authors found a significantly higher incidence of cardiovascular endpoint and in-stent thrombosis in those treated with first-generation in comparison to second-generation DES within all three glycemic groups [ 155 ]. This confirmation is important since prior evidence of the relative benefits of newer DES generations in DM patients post-MI was limited.…”