***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To retrospectively evaluate the 12-month effectiveness of the Endeavor zotarolimus-eluting stent ( ZES ) in diabetic versus non-diabetic patients enrolled in the E-Five Registry . Design and Setting The E-Five Registry is a prospect i ve , multicentre registry of 8314 patients presenting with symptomatic coronary artery disease treated with the Endeavor ( ZES ) .  Patients were treated at 188 centres located in 37 countries across Europe , Latin America and Asia Pacific . Patients There were 2721 ( 32.7 % ) patients with diabetes ( DM ) and among these patients 682 were insulin-treated ( ITDM ) and 2039 were non-insulin-treated diabetic patients ( NITDM ) . Interventions All enrolled patients received an Endeavor ZES and were followed for 12 months . Main outcome measurements The primary outcome measure was major adverse cardiac event ( MACE ) at 12 months . Secondary endpoints included target lesion revascularisation ( TLR ) , target vessel revascularisation ( TVR ) , target vessel failure ( TVF ) and stent thrombosis . Results Compared with non-DM patients , DM patients had higher rates of MACE ( 9.7 % vs 6.4 % , p<0.001 ) , TLR ( 5.3 % vs 4.0 % , p=0.028 ) and Academic Research Consortium ( ARC ) definite and probable stent thrombosis ( 1.5 % vs 0.9 % , p=0.041 ) . Compared with non-DM patients , ITDM patients had higher rates of MACE ( 12.6 % vs 6.4 % , p<0.001 ) . ITDM patients had higher rates of death ( 6.7 % vs 1.7 % , p<0.001 ) , cardiac death ( 4.5 % vs 1.2 % , p<0.001 ) and TLR ( 6.5 % vs 4.0 % , p=0.011 ) than non-DM patients . Conclusions The Endeavor ZES performed well in DM patients ; however , DM patients experienced higher rates of adverse clinical events compared with non-DM patients . Trial Reg No Clinical trial registration information : http://www . clinical trials.gov ; Unique identifier : OBJECTIVES The aim of this study was to examine outcomes related to the use of the Endeavor zotarolimus-eluting stent ( ZES ) ( Medtronic CardioVascular , Santa Rosa , California ) compared with the TAXUS paclitaxel-eluting stent ( PES ) ( Boston Scientific Corp. , Natick , Massachusetts ) in the 477 patients with diabetes mellitus ( DM ) enrolled in the r and omized ENDEAVOR IV ( R and omized Comparison of Zotarolimus- and Paclitaxel-Eluting Stents in Patients with Coronary Artery Disease ) trial . BACKGROUND Percutaneous coronary intervention ( PCI ) in diabetic patients is associated with increased rates of restenosis-related end points compared with PCI in nondiabetic patients . Although ZES has been associated with similar clinical efficacy compared with PES in the overall trial population of the ENDEAVOR IV trial , whether these results are maintained in the higher-risk restenosis subgroup of patients with DM has not been determined . METHODS Clinical and angiographic outcomes were compared according to r and omized treatment assignment to either ZES or PES . RESULTS Baseline characteristics were similar among  ZES ( n = 241 ) and PES ( n = 236 ) diabetic patients , with slightly longer lesion lengths in PES-treated patients ( 12.9 mm vs. 14.0 mm , p = 0.041 ) . Among the 86 DM patients assigned to routine angiographic follow-up ( 18 % of the overall DM cohort ) , in-stent percent diameter stenosis at 8 months was greater among ZES-treated patients ( 32.9 vs. 21.1 , p = 0.023 ) , with a trend toward higher in-stent late loss . One-year clinical outcomes were similar among DM patients treated with either ZES or PES ( target vessel failure : 8.6 % vs. 10.8 % , p = 0.53 ; target lesion revascularization : 6.9 % vs. 5.8 % , p = 0.70 ; target vessel revascularization : 8.6 % vs. 9.4 % , p = 0.87 ) . There were no significant interactions between DM status and stent type with respect to the outcomes measured , and the relative efficacy/safety of ZES and PES were similar among insulin- and noninsulin-requiring subgroups . CONCLUSIONS One-year clinical outcomes were similar among DM patients treated with ZES and PES in the ENDEAVOR IV trial . These findings parallel the overall trial results , which demonstrated similar efficacy and safety of ZES and PES for single de novo coronary lesions Background —Diabetes portends an adverse prognosis in patients undergoing percutaneous coronary intervention ( PCI ) .  Whether improvements in current clinical practice ( stents , IIb/IIIa antagonists ) have result ed in substantial improvement of these outcomes remains an issue . The aim of this study was to determine the influence of diabetes on 9-month outcomes of patients undergoing PCI in the current era . Methods and Results —The 11 482 patients enrolled in the Prevention of REStenosis with Tranilast and its Outcomes ( PRESTO ) Trial were stratified according to the presence ( n=2694 ) or absence ( n=8798 ) of diabetes . Diabetic patients were older ; were more likely to be female ; had a higher proportion of congestive failure , hypertension , prior CABG , and unstable angina ; and had higher body mass index and lower ejection fraction than nondiabetic patients ( P < 0.01 for all comparisons ) . The degree of multivessel disease was similar between the two groups . American College of Cardiology/American Heart Association type C lesions were more common in diabetic patients ( 17 % versus 15 % , P < 0.01 ) . Angiographic and procedural success rates and in-hospital events were similar between the two groups . The primary end point of death , myocardial infa rct ion , or target vessel revascularization ( TVR ) was analyzed as time-to-first event within 9 months of the index PCI . After adjusting for certain baseline characteristics , diabetes was independently associated with death at 9 months ( relative risk [ RR ] , 1.87 ; 95 % CI , 1.31 to 2.68 , P < 0.01 ) and with an increased likelihood of TVR ( RR , 1.27 ; 95 % CI , 1.14 to 1.42 , P < 0.01 ) , as well as the composite end point of death/myocardial infa rct ion/TVR ( RR , 1.26 ; 95 % CI , 1.13 to 1.40 , P < 0.01 ) . Conclusions —Despite advances in interventional techniques , diabetes remains a significant independent predictor of adverse events in the intermediate term after PCI OBJECTIVES This prespecified subgroup analysis examined the effect of diabetes on left main coronary disease ( LM ) and /or three-vessel disease ( 3VD ) in patients treated with percutaneous coronary intervention ( PCI ) or coronary artery bypass grafting ( CABG ) in the SYNTAX trial . METHODS Patients ( n = 1800 ) with LM and /or 3VD were r and omized to receive either PCI with TAXUS Express paclitaxel-eluting stents or CABG . Five-year outcomes in subgroups with ( n = 452 ) or without ( n = 1348 ) diabetes were examined : major adverse cardiac or cerebrovascular events ( MACCE ) , the composite safety end-point of all-cause death/stroke/myocardial infa rct ion ( MI ) and individual MACCE components death , stroke , MI and repeat revascularization . Event rates were estimated with Kaplan-Meier analyses . RESULTS In diabetic patients , 5-year rates were significantly higher for PCI vs CABG for MACCE ( PCI : 46.5 % vs CABG : 29.0 % ; P < 0.001 ) and repeat revascularization ( PCI : 35.3 % vs CABG : 14.6 % ; P < 0.001 ) . There was no difference in the composite of all-cause death/stroke/MI ( PCI : 23.9 % vs CABG : 19.1 % ; P = 0.26 ) or individual components all-cause death ( PCI : 19.5 % vs CABG : 12.9 % ; P = 0.065 ) , stroke ( PCI : 3.0 % vs CABG : 4.7 % ; P = 0.34 ) or MI ( PCI : 9.0 % vs CABG : 5.4 % ; P = 0.20 ) . In non-diabetic patients , rates with PCI were also higher for MACCE ( PCI : 34.1 % vs CABG : 26.3 % ; P = 0.002 ) and repeat revascularization ( PCI : 22.8 % vs CABG : 13.4 % ; P < 0.001 ) , but not for the composite end-point of all-cause death/stroke/MI ( PCI : 19.8 % vs CABG : 15.9 % ; P = 0.069 ) . There were no differences in all-cause death ( PCI : 12.0 % vs CABG : 10.9 % ; P = 0.48 ) or stroke ( PCI : 2.2 % vs CABG : 3.5 % ; P = 0.15 ) , but rates of MI  ( PCI : 9.9 % vs CABG : 3.4 % ; P < 0.001 ) were significantly increased in the PCI arm in non-diabetic patients . CONCLUSIONS In both diabetic and non-diabetic patients , PCI result ed in higher rates of MACCE and repeat revascularization at 5 years . Although PCI is a potential treatment option in patients with less-complex lesions , CABG should be the revascularization option of choice for patients with more-complex anatomic disease , especially with concurrent diabetes Background —R and omized clinical trials have shown that a sirolimus-eluting stent significantly reduces restenosis after percutaneous coronary revascularization . Diabetic patients are known to have a higher risk of restenosis compared with nondiabetic patients . The purpose of this analysis was to determine the impact of sirolimus-eluting stents on outcomes of diabetic compared with nondiabetic patients . Methods and Results —The SIRIUS ( SIRolImUS-coated Bx Velocity balloon-exp and able stent in the treatment of patients with de novo coronary artery lesions ) trial is a r and omized , double-blind study that compared sirolimus-eluting and bare metal stent implantation in 1058 patients with de novo native coronary artery lesions . Diabetes mellitus was present in 279 ( 26 % ) patients ( diabetes mellitus group , 131 patients received sirolimus-eluting stents  and 148 patients received bare metal stents )  and was absent in 778 patients ( no – diabetes mellitus group , 402 patients received sirolimus-eluting stents and 376 patients received bare metal stents ) . At 270 days , target lesion revascularization was reduced in diabetic patients from 22.3 % with bare metal stents to 6.9 % with sirolimus-eluting stents ( P < 0.001 ) and in nondiabetic patients from 14.1 % to 2.99 % ( P < 0.001 ) , respectively . Major adverse cardiac events were reduced in diabetic patients from 25 % with bare metal stents to 9.2 % with sirolimus-eluting stents ( P < 0.001 ) and from 16.5 % to 6.5 % ( P < 0.001 ) in nondiabetic patients , respectively . Conclusions —Implantation of sirolimus-eluting stents compared with bare metal stents in de novo coronary lesions reduces major adverse cardiac events in patients with and without diabetes mellitus . However , among patients receiving sirolimus-eluting stents , there remains a trend toward a higher frequency of repeat intervention in diabetic patients compared with nondiabetic patients , particularly in the insulin-requiring patients OBJECTIVES We sought to determine the safety and efficacy of polymer-regulated site-specific delivery of paclitaxel in patients with diabetes mellitus undergoing stent implantation . BACKGROUND Percutaneous coronary intervention in patients with diabetes is associated with high rates of restenosis and repeat revascularization due to excessive neointimal proliferation , a process that may be blunted with the site-specific delivery of paclitaxel . METHODS In the TAXUS-IV trial , 1,314 patients were prospect ively r and omized to the slow rate-release polymer-based paclitaxel-eluting TAXUS stent or the bare-metal EXPRESS stent  ( Boston Scientific Corp. , Natick , Massachusetts ) . Medically treated diabetes was present in 318 patients ( 24 % ) , 105 of whom required insulin . RESULTS Among patients with diabetes , the TAXUS stent , compared to the bare-metal stent , reduced the rate of 9-month binary angiographic restenosis by 8 
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Long-term cardiovascular outcomes were also significantly higher in insulin-treated DM patients .
Conclusion Insulin treatment in these DM patients was associated with a significantly higher short and long-term adverse cardiovascular outcomes after PCI compared to those DM patients not treated by insulin therapy