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New study compares Taxus Express results in diabetics and non-diabetics

Boston Scientific : 13 May, 2008  (Company News)
Boston Scientific has released results from an analysis of nearly 7,500 patients from its TAXUS ARRIVE 1 and 2 registries, which are designed to confirm the performance of the Taxus Express Paclitaxel-Eluting Coronary Stent System in real-world practice.
The two-year pooled ARRIVE data showed that the Taxus Stent had similarly low rates of myocardial infarction (MI), Stent thrombosis, and target vessel re-intervention (TVR) across both diabetic and non-diabetic patients. Analysis of the data was presented by David A Cox, MD, FACC, and John M Lasala, MD, PhD, FACC, at the annual EuroPCR Scientific Programme in Barcelona, Spain.

'The ARRIVE diabetic subset data demonstrated that the TAXUS Stent mitigated the adverse effect of diabetes as a risk factor for restenosis and repeat procedures in the patients studied,' said Dr Cox of Lehigh Valley Hospital in Allentown, Pennsylvania. 'While the diabetic patients had more cardiac risk factors, comorbidities and higher mortality than non-diabetics, the rates of re-intervention, MI and Stent thrombosis in the ARRIVE 1 and 2 registries were similar in both groups, regardless of risk profile.'

The pooled analysis included two-year data on 2,112 medication-requiring diabetic patients and 5,380 non-diabetic patients from the ARRIVE registry programme. The population was further segmented into a higher-risk group(1) and a lower-risk group(2). Due to significant disparity in baseline characteristics between diabetic and non-diabetic patients, multivariate modeling and analysis was used to allow for adjustment of baseline differences (other than the presence of diabetes) between the two groups.

In the ARRIVE registry analysis, the Taxus Stent maintained comparable re-intervention rates in the diabetic and non-diabetic patient populations in ARRIVE 1 and 2. Cumulative two-year TVR rates, whether adjusted or unadjusted, were similar between diabetic and non-diabetic patients, respectively (9.8 percent vs 9.0 percent, p=0.57, adjusted).

Diabetic patients in the higher-risk subgroup actually had lower adjusted TVR rates than non-diabetic patients (9.5 percent vs 11.3 percent, p=0.01). Taxus Stent-related re-intervention of a target vessel (equivalent to target lesion revascularization, or TLR) was also similar between the patient groups (7.1 percent vs 6.8 percent, p=0.31), despite the known higher risk for re-intervention in diabetic patients. In the higher-risk subgroup, two-year TLR was actually lower in diabetic patients after adjustment for baseline differences (7.3 percent vs 8.7 percent, p=0.03).

Safety outcomes showed that diabetic patients treated with the Taxus Stent in the ARRIVE registry had similar rates of MI (3.2 percent vs 2.6 percent, p=0.29) and ARC Definite/Probable Stent thrombosis (2.3 percent vs. 1.9 percent, p=0.27) compared to non-diabetic patients. The similarities held in both the higher- and lower-risk diabetic populations whether or not multivariate adjustment was used.

The results also showed that both higher- and lower-risk diabetic patients had the expected increased overall adjusted two-year mortality rate compared to patients without diabetes (7.1 percent vs. 3.9 percent, p less than 0.001), as well as increased cardiac death (4.4 percent vs. 2.1 percent, p less than 0.001), reflecting the more advanced cardiac disease and increased comorbid risk factors associated with diabetes.

'Our extensive ARRIVE registries provide valuable insights into diabetic patients who are often at higher risk for adverse events and repeat stenting procedures,' said Paul LaViolette, chief operating officer at Boston Scientific. 'The ARRIVE data demonstrated that the Taxus Stent lessened the risk factor for clinical restenosis in the diabetic patients studied.'

The growing diabetic subset accounts for more than one-quarter of all coronary interventional procedures in the United States. Diabetes is generally associated with an increased risk of cardiovascular events and patients with diabetes are more likely than non-diabetic patients to require repeat procedures due to a higher incidence of restenosis following angioplasty and stenting.

In the USA, the Taxus Stent is not specifically indicated for use in patients with diabetes.
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