Differences in restenosis rate with different drug-eluting stents in patients with and without diabetes mellitus: a report from the SCAAR (Swedish Angiography and Angioplasty Registry)

J Am Coll Cardiol. 2009 May 5;53(18):1660-7. doi: 10.1016/j.jacc.2009.01.054.


Objectives: Our aim was to evaluate restenosis rate of drug-eluting stents (DES) in patients with and without diabetes mellitus (DM) in a real-world setting.

Background: DES seem less effective in patients with DM.

Methods: The SCAAR (Swedish Coronary Angiography and Angioplasty Registry) includes all patients undergoing percutaneous coronary intervention in Sweden. From April 1, 2004, to April 20, 2008, all restenoses detected at a subsequent angiography and all DES types implanted at more than 500 occasions were assessed using Cox regression.

Results: Four DES types qualified for inclusion. In total, 35,478 DES were implanted at 22,962 procedures in 19,004 patients and 1,807 restenoses were reported over a mean 29 months follow-up. In the entire population, the restenosis rate per stent was 3.5% after 1 year and 4.9% after 2 years. The adjusted risk of restenosis was higher in patients with DM compared with that in patients without DM (relative risk [RR]: 1.23, 95% confidence interval [CI]: 1.10 to 1.37). In patients with DM, restenosis was twice as frequent with the zotarolimus-eluting Endeavor stent (Medtronic, Minneapolis, Minnesota) compared with that in the other DES types. The Endeavor stent and the sirolimus-eluting Cypher stent (Cordis, Johnson & Johnson, Miami, Florida) had higher restenosis rates in patients with DM compared with those in patients without DM (RR: 1.77, 95% CI: 1.29 to 2.43 and RR: 1.25, 95% CI: 1.04 to 1.51). Restenosis rate with the paclitaxel-eluting Taxus Express and Liberté (Boston Scientific, Natick, Massachusetts) stents was unrelated to DM. Mortality did not differ between different DES.

Conclusions: Restenosis rate with DES was higher in patients with DM compared with that in patients without DM. There seem to be important differences between different brands of DES.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Case-Control Studies
  • Confidence Intervals
  • Coronary Angiography
  • Coronary Artery Disease / drug therapy
  • Coronary Artery Disease / therapy
  • Coronary Restenosis / epidemiology
  • Coronary Restenosis / prevention & control*
  • Databases as Topic
  • Diabetes Complications* / epidemiology
  • Diabetes Complications* / prevention & control
  • Diabetes Complications* / therapy
  • Drug-Eluting Stents*
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Male
  • Paclitaxel / therapeutic use*
  • Proportional Hazards Models
  • Registries
  • Risk
  • Sirolimus / analogs & derivatives*
  • Sirolimus / therapeutic use
  • Sweden / epidemiology
  • Tubulin Modulators / therapeutic use


  • Immunosuppressive Agents
  • Tubulin Modulators
  • zotarolimus
  • Paclitaxel
  • Sirolimus