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Volume 96, Issue 10, Pages 1393-1398 (15 November 2005)


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Effect of Sirolimus-Eluting Stent in Diabetic Patients With Small Coronary Arteries (A SES-SMART Substudy)

SES-SMART InvestigatorsPaolo Ortolani, MDaCorresponding Author Informationemail address, Diego Ardissino, MDb, Claudio Cavallini, MDc, Ezio Bramucci, MDd, Ciro Indolfi, MDe, Matteo Aquilina, MDa, Antonio Marzocchi, MDa

Received 22 May 2005; received in revised form 7 July 2005; accepted 7 July 2005. published online 28 September 2005.

Randomized clinical trials have shown that sirolimus-eluting stents (SESs) decrease restenosis rates compared with bare metal stents (BMSs), but their efficacy among patients who have diabetes mellitus remains to be established. This study investigated the effect of SES implantation in a high-risk population (i.e., patients who had diabetes and small coronary vessel disease). For this purpose, we analyzed outcomes of the subset of patients who had diabetes and were enrolled in the SES-SMART, a randomized trial that compared the results of implantation of SESs and BMSs in small coronary arteries. Twenty-nine patients who had diabetes were originally randomized to receive SESs and 45 patients received BMSs. The use of SESs was associated with ∼60% decreases in the relative incidence of in-segment angiographic restenosis (63% vs 25%, p = 0.003) and in-segment late loss (0.76 vs 0.28 mm, p <0.002). Angiographic patterns of restenosis were more favorable in the SES group. SES implantation was associated with a 15% absolute decrease in adverse clinical events. In patients who had insulin-dependent diabetes mellitus, SESs showed a high in-segment restenosis rate (40%) that was principally due to persistent restenosis. In conclusion, in diabetics with small coronary arteries, SES implantation significantly reduces the incidence of the 8-month angiographic restenosis rate compared with BMSs.

a Institute of Cardiology, Policlinico S. Orsola, University of Bologna, Bologna, Italy

b Division of Cardiology, Ospedale Maggiore, University of Parma, Parma, Italy

c Division of Cardiology, Ospedale Cà Foncello, Treviso, Italy

d Division of Cardiology, Policlinico S. Matteo, University of Pavia, Pavia, Italy

e Division of Cardiology, University of Magna Grecia, Catanzaro, Italy.

Corresponding Author InformationCorresponding author: Tel/fax: 3905-1636-4477.

PII: S0002-9149(05)01346-9

doi:10.1016/j.amjcard.2005.07.049


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