Stent Thrombosis in Diabetic and NonDiabetic Patients After SirolimusEluting Stent Implantation The

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Stent Thrombosis in Diabetic and Non-Diabetic
Patients After Sirolimus-Eluting Stent
ImplantationThe EVASTENT Registry

• Adapted fromMachecourt et al. J Am Coll Cardiol
  20750501-508

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Stent Thrombosis in EVASTENT
Objective

• To assess the frequency and causes of stent
  thrombosis in diabetic and non-diabetic patients
  following sirolimus-eluting stent (Cypher,
  Cordis) implantation

Machecourt et al. J Am Coll Cardiol 20750501-508
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Stent Thrombosis in EVASTENT
Study Population

• Consecutive patients undergoing sirolimus-eluting
  stent implantation (N1,731)
• Diabetic and non-diabetic patients enrolled in
  11 ratio
• Exclusion off-label use of sirolimus-eluting
  stents (acute ST-elevation myocardial infarction
  lt48 h, left main or saphenous vein graft
  stenosis, bifurcation lesion, total chronic
  occlusion) or incomplete revascularization
• Dual aspirin-clopidogrel therapy indicated for 3
  months post-procedure (optional thereafter)

Machecourt et al. J Am Coll Cardiol 20750501-508
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Stent Thrombosis in EVASTENT
Baseline Characteristics
Machecourt et al. J Am Coll Cardiol 20750501-508
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Stent Thrombosis in EVASTENT
Major Adverse Cardiac Events
P0.001
Machecourt et al. J Am Coll Cardiol 20750501-508
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Stent Thrombosis in EVASTENT
Major Adverse Cardiac Events (by Diabetes
Vessel Disease)
Machecourt et al. J Am Coll Cardiol 20750501-508
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Stent Thrombosis in EVASTENT
Stent Thrombosis
P0.03
Machecourt et al. J Am Coll Cardiol 20750501-508
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Stent Thrombosis in EVASTENT
Stent Thrombosis (by Diabetes Vessel Disease)
Machecourt et al. J Am Coll Cardiol 20750501-508
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Stent Thrombosis in EVASTENT
All-Cause Mortality
Plt0.001
Machecourt et al. J Am Coll Cardiol 20750501-508
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Stent Thrombosis in EVASTENT
All-Cause Mortality (by Diabetes Vessel Disease)
Machecourt et al. J Am Coll Cardiol 20750501-508
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Stent Thrombosis in EVASTENT
Other 1-Year Outcomes
Machecourt et al. J Am Coll Cardiol 20750501-508
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Stent Thrombosis in EVASTENT
Other 1-Year Outcomes (by Insulin Treatment)
P0.006
P0.01
P0.004
P0.03
P0.001
Machecourt et al. J Am Coll Cardiol 20750501-508
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Stent Thrombosis in EVASTENT
Multivariable Predictors of Stent Thrombosis
Machecourt et al. J Am Coll Cardiol 20750501-508
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Stent Thrombosis in EVASTENT
Conclusions

• Diabetic patients undergoing sirolimus-eluting
  stent implantation have higher rates of stent
  thrombosis compared to non-diabetic patients
• Insulin-treated diabetic patients have higher
  rates of stent thrombosis and target vessel and
  lesion revascularization
• Insulin-treated diabetes is a significant
  multivariable risk factor for stent thrombosis
• Early withdrawal of dual antiplatelet therapy may
  contribute to higher rates of late stent
  thrombosis

Machecourt et al. J Am Coll Cardiol 20750501-508