Meta-Analysis Comparing Efficacy and Safety of First Generation Drug-Eluting Stents to Bare-Metal Stents in Patients With Diabetes Mellitus Undergoing Primary Percutaneous Coronary Intervention

Several concerns have emerged regarding the higher risk for stent thrombosis (ST) after drug-eluting stent (DES) implantation, especially in the setting of ST-segment elevation myocardial infarction (STEMI). Few data have been reported so far in patients with diabetes mellitus, which is associated w...

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Published in:The American journal of cardiology 2013-05, Vol.111 (9), p.1295-1304
Main Authors: De Luca, Giuseppe, MD, Dirksen, Maurits T., MD, Spaulding, Christian, MD, Kelbæk, Henning, MD, Schalij, Martin, MD, Thuesen, Leif, MD, van der Hoeven, Bas, MD, Vink, Marteen A., MD, Kaiser, Christopher, MD, Musto, Carmine, MD, Chechi, Tania, MD, Spaziani, Gaia, MD, Diaz de la Llera, Luis Salvador, MD, Pasceri, Vincenzo, MD, Di Lorenzo, Emilio, MD, Violini, Roberto, MD, Suryapranata, Harry, MD, Stone, Gregg W., MD
Format: Article
Language:English
Subjects:
Angioplasty
Cardiovascular
Confidence intervals
Diabetes Mellitus - mortality
Drug-Eluting Stents
Global Health
Heart attacks
Humans
Ischemia
Mortality
Myocardial Infarction - complications
Myocardial Infarction - mortality
Myocardial Infarction - surgery
Percutaneous Coronary Intervention - methods
Prosthesis Design
Stents
Stroke
Survival Rate
Thrombosis
Variables
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Summary:Several concerns have emerged regarding the higher risk for stent thrombosis (ST) after drug-eluting stent (DES) implantation, especially in the setting of ST-segment elevation myocardial infarction (STEMI). Few data have been reported so far in patients with diabetes mellitus, which is associated with high rates of target vessel revascularization after bare-metal stent (BMS) implantation but also higher rates of ST after DES implantation. Therefore, the aim of this study was to perform a meta-analysis of individual patients’ data to evaluate the long-term safety and effectiveness of DES compared with BMS in patients with diabetes who undergo primary percutaneous coronary intervention for STEMI. Published reports were scanned by formal searches of electronic databases (MEDLINE and CENTRAL). All completed randomized trials of DES for STEMI were examined. No language restrictions were enforced. Individual patients’ data were obtained from 11 of 13 trials, including a total of 972 patients with diabetes (616 [63.4%] randomized to DES and 356 [36.6%] to BMS). At long-term follow-up (median 1,095 days, interquartile range 1,087 to 1,460), DES significantly reduced the occurrence of target vessel revascularization (hazard ratio 0.42, 95% confidence interval 0.29 to 0.59, p 1 year) with DES. In conclusion, this meta-analysis, based on individual patients’ data from 11 randomized trials, showed that among patients with diabetes with STEMIs who undergo primary percutaneous coronary intervention, sirolimus-eluting stents and paclitaxel-eluting stents, compared with BMS, are associated with a significant reduction in target vessel revascularization at long-term follow-up, without any apparent concern in terms of mortality, despite the trend toward higher rates of reinfarction and ST.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2013.01.281