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Study examines performance of stents in diabetics

Boston Scientific : 31 March, 2008  (New Product)
Boston Scientific has released results from an analysis of 4,772 patients from its Taxus Arrive 1 and 2 registries that were designed to assess the performance of the Taxus Express2 Paclitaxel-Eluting Coronary Stent System in real-world practice.
The one-year pooled Arrive data confirmed the known higher mortality rate for diabetics versus non-diabeticswith cardiovascular disease, but showed that the Taxus Stent had similarly low rates of stent-related cardiac death, myocardial infarction (MI), Stent thrombosis, and major cardiac events (MCE) across those two patient subsets.

The study also showed similar rates of target vessel re-intervention (TVR) and Taxus -related TVR in indicated patients per the European Union (EU) label, whether or not they had diabetes. Analysis of the data was presented by D Lynn Morris, MD, at the SCAI Annual Scientific Sessions in Partnership with the ACC/i2 Summit in Chicago.

The pooled analysis included one-year data on 1,530 medication-requiring diabetic patients and 3,242 non-diabetic patients from the Arrive registry programme. Due to significant disparity in baseline characteristics between diabetic and non-diabetic patients, propensity score analysis was used to allow for adjustment of baseline differences (other than the presence of diabetes) between the two groups.

The results showed diabetic patients had the well-known higher overall adjusted one-year mortality rate than patients without diabetes (3.7 percent vs 2.3 percent, respectively, p=0.016), with the difference being driven by the cardiac death rate (2.3 percent vs. 1.2 percent, p=0.014), and reflecting the more advanced cardiac disease associated with diabetes. However, this difference was not related to the Taxus Stent as the Taxus Stent-related cardiac death rates at one-year were comparable in diabetics and non-diabetics, respectively (1.0 percent vs. 0.7 percent, p=0.29) in this patient population. Additionally, Taxus Stent-related MCE rates (cardiac death, MI, and re-intervention) at one year were comparable (5.7 percent vs. 5.6 percent, p=0.80), as was the incidence of Taxus Stent-related MI (1.6 percent vs 1.2 percent, p=0.26), in both groups.

Stent thrombosis at one year was low and showed no significant difference between diabetics and non-diabetics under Protocol definition (1.5 percent vs. 1.3 percent, p=0.59) or ARC Definite/Probable (1.7 percent vs 1.2 percent, p=0.29). Unadjusted one-year rates of Taxus Stent-related cardiac death, Taxus Stent-related MCE, Taxus Stent-related MI, and protocol-defined Stent thrombosis showed no differences between the two populations (p-values of 0.30, 0.74, 0.31, and 0.65, respectively), suggesting that the safety profile is comparable for the two groups despite increased underlying risk in patients with diabetes.

Additionally, the Arrive analysis confirmed that the Taxus Stent maintained comparable re-intervention rates in the diabetic and non-diabetic patient populations in Arrive 1 and 2. Rates of one-year TVR, whether adjusted or unadjusted, were similar between the patient groups (6.1 percent vs. 6.0 percent, p=0.80, adjusted). Taxus Stent-related re-intervention of a target vessel (equivalent to target lesion revascularisation, or TLR) was also similar between the patient groups (4.3 percent vs. 4.5 percent, p=0.70), despite the known higher risk for re-intervention in diabetic patients.

'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 Morris of the Albert Einstein Medical Center in Philadelphia, Pennsylvania. 'While the diabetic patients had more cardiac risk factors and co-morbidities than non-diabetics, the Taxus - related cardiac death, MI and Stent thrombosis in the Arrive 1 and 2 registries were similar in both groups, even without adjustment for risk factors.'

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

The growing diabetic subset accounts for more than one-quarter of all coronary interventional procedures in the USA. 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.

The safety and effectiveness of the Taxus Express Stent has not been established in patients with diabetes in the USA.
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