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Meta-Analysis
. 2012 Aug 10:345:e5170.
doi: 10.1136/bmj.e5170.

Outcomes with various drug eluting or bare metal stents in patients with diabetes mellitus: mixed treatment comparison analysis of 22,844 patient years of follow-up from randomised trials

Sripal Bangalore  1 , Sunil Kumar, Mario Fusaro, Nicholas Amoroso, Ajay J Kirtane, Robert A Byrne, David O Williams, James Slater, Donald E Cutlip, Frederick Feit
Affiliations
Meta-Analysis

Outcomes with various drug eluting or bare metal stents in patients with diabetes mellitus: mixed treatment comparison analysis of 22,844 patient years of follow-up from randomised trials

Sripal Bangalore et al. BMJ. .

Abstract

Objectives: To evaluate the efficacy and safety of currently used drug eluting stents compared with each other and compared with bare metal stents in patients with diabetes.

Design: Mixed treatment comparison meta-analysis.

Data sources and study selection: PubMed, Embase, and CENTRAL were searched for randomised clinical trials, until April 2012, of four durable polymer drug eluting stents (sirolimus eluting stents, paclitaxel eluting stents, everolimus eluting stents, and zotarolimus eluting stents) compared with each other or with bare metal stents for the treatment of de novo coronary lesions and enrolling at least 50 patients with diabetes.

Primary outcomes: Efficacy (target vessel revascularisation) and safety (death, myocardial infarction, stent thrombosis).

Results: From 42 trials with 22,844 patient years of follow-up, when compared with bare metal stents (reference rate ratio 1) all of the currently used drug eluting stents were associated with a significant reduction in target vessel revascularisation (37% to 69%), though the efficacy varied with the type of stent (everolimus eluting stents~sirolimus eluting stents>paclitaxel eluting stents~zotarolimus eluting stent>bare metal stents). There was about an 87% probability that everolimus eluting stents were the most efficacious compared with all others, though there were limited usable data for the zotarolimus eluting Resolute stent in patients with diabetes. Moreover, there was no increased risk of any safety outcome (including very late stent thrombosis) with any drug eluting stents compared with bare metal stents. There was about a 62% probability that the everolimus eluting stent was the safest stent for the outcome of "any" stent thrombosis.

Conclusions: Among patients with diabetes treated with coronary stents all currently available drug eluting stents were efficacious without compromising safety compared with bare metal stents. There were relative differences among the drug eluting stents, such that the everolimus eluting stent was the most efficacious and safe.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that SB is on the advisory boards of Boehringer Ingelheim and Daiichi Sankyo and DEC was prinicpal investigator on the Medtronic EDUCATE trial.

Figures

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Fig 1 Selection of studies examining efficacy or safety, or both, of various drug eluting or bare metal stents in patients with diabetes mellitus
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Fig 2 Network of comparisons of types of stents in studies examining efficacy or safety, or safety, of various drug eluting or bare metal stents in patients with diabetes mellitus. Links between stent types represent direct comparisons (solid line) or indirect comparisons (dashed line). Numbers along links represent number of trial arms providing direct comparison between stent types
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Fig 3 Stent type and risk of target vessel revascularisation and target lesion revascularisation with 95% credibility intervals
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Fig 4 Stent type and risk of myocardial infarction and death with 95% credibility intervals
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Fig 5 Stent type and risk of any stent thrombosis, definite or probable stent thrombosis, definite stent thrombosis, and very late stent thrombosis with 95% credibility intervals
See this image and copyright information in PMC

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References

    1. Kip KE, Faxon DP, Detre KM, Yeh W, Kelsey SF, Currier JW. Coronary angioplasty in diabetic patients. The National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. Circulation 1996;94:1818-25. - PubMed
    1. Abizaid A, Kornowski R, Mintz GS, Hong MK, Abizaid AS, Mehran R, et al. The influence of diabetes mellitus on acute and late clinical outcomes following coronary stent implantation. J Am Coll Cardiol 1998;32:584-9. - PubMed
    1. Scheen AJ, Warzee F, Legrand VM. Drug-eluting stents: meta-analysis in diabetic patients. Eur Heart J 2004;25:2167-89. - PubMed
    1. Scheen AJ, Warzee F. Diabetes is still a risk factor for restenosis after drug-eluting stent in coronary arteries. Diabetes Care 2004;27:1840-1. - PubMed
    1. Daemen J, Garcia-Garcia HM, Kukreja N, Imani F, de Jaegere PP, Sianos G, et al. The long-term value of sirolimus- and paclitaxel-eluting stents over bare metal stents in patients with diabetes mellitus. Eur Heart J 2007;28:26-32. - PubMed

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