The effect of drug-eluting stents on intermediate angiographic and clinical outcomes in diabetic patients: Insights from randomized clinical trials - 08/08/11
This study was presented in part at the 78th Annual Scientific Sessions of the American Heart Association in Dallas, TX, on November 15, 2005.
Résumé |
Objective |
Implantation of drug-eluting stents has emerged as the predominant percutaneous revascularization strategy in diabetic patients, despite limited outcomes data. Accordingly, our aim was to conduct a meta-analysis to assess the benefit and safety profile of drug-eluting stents in diabetic patients.
Methods |
We included randomized trials comparing either the paclitaxel- or sirolimus-eluting stent with a bare-metal stent or with each other in diabetic patients during a follow-up of at least 6 months.
Results |
A total of 16 studies were identified, which included 2951 diabetic patients who were followed up for 6 to 12 months. Target lesion revascularization was less frequently performed in patients who received drug-eluting stents compared with bare-metal stents (risk ratio [RR] 0.35, 95% CI 0.27-0.46, P < .0001). Similar reductions were noted in the incidence of major adverse cardiovascular events (RR 0.42, 95% CI 0.31−0.56, P < .0001), in-segment restenosis (RR 0.31, 95% CI 0.25-0.40, P < .0001), and non–Q-wave myocardial infarction (RR 0.57, 95% CI 0.32-0.99, P = .046). Event rates were similar for Q-wave myocardial infarction (RR 0.72, 95% CI 0.25-2.07, P = .54), death (RR 0.64, 95% CI 0.32-1.28, P = .20), and stent thrombosis (RR 0.41, 95% CI 0.13-1.27, P = .12).
Conclusions |
In conclusion, diabetic patients who receive drug-eluting stents have a significantly lower incidence of target lesion revascularization, in-segment restenosis and myocardial infarction at 6 to 12 months, compared with bare-metal stents. The rates of mortality and stent thrombosis are similar.
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| Dr Bavry has received honoraria for consulting from Genesis Associates, Boston Scientific, The Frankel Group, HRA, Propagate Pharma, and Hagen/Sinclair Research Recruiting. Dr Bhatt discloses the following relationships: research grants (directly to the institution)—Bristol Myers Squibb, Eisai, Ethicon, Sanofi Aventis, The Medicines Company; honoraria (currently donated to nonprofits)—Astra Zeneca, Bristol Myers Squibb, Centocor, Daiichi-Sankyo, Eisai, Eli Lilly, Glaxo Smith Kline, Millennium, Paringenix, PDL, Sanofi Aventis, Schering Plough, The Medicines Company, and TNS Healthcare; speaker's bureau (not current, >2 years ago)—Bristol Myers Squibb, Sanofi Aventis, and The Medicines Company; consultant/advisory board (currently donated to nonprofits)—Astra Zeneca, Bristol Myers Squibb, Cardax, Centocor, Cogentus, Daiichi-Sankyo, Eisai, Eli Lilly, Glaxo Smith Kline, Johnson & Johnson, McNeil, Medtronic, Millennium, Otsuka, Paringenix, PDL, Philips, Portola, Sanofi Aventis, Schering Plough, The Medicines Company, TNS Healthcare, and Vertex; expert testimony regarding clopidogrel: the compensation was donated to a nonprofit organization. Cleveland Clinic Coordinating Center currently receives or has received research funding from Abraxis, Alexion Pharma, AstraZeneca, Atherogenics, Aventis, Biosense Webster, Biosite, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Cardionet, Centocor, Converge Medical Inc, Cordis, Dr Reddy's, Edwards Lifesciences, Esperion, GE Medical, Genentech, Gilford, GSK, Guidant, J&J, Kensey-Nash, Lilly, Medtronic, Merck, Mytogen, Novartis, Novo Nordisk, Orphan Therapeutics, P&G Pharma, Pfizer, Roche, Sankyo, Sanofi-Aventis, Schering-Plough, Scios, St Jude Medical, Takeda, and TMC, VasoGenix, Viacor. |
Vol 155 - N° 4
P. 640-647 - avril 2008 Retour au numéro
Article précédent
- Comparative safety and efficacy of a sirolimus-eluting versus paclitaxel-eluting stent: A meta-analysis
- Hitinder S. Gurm, Thomas Boyden, Kathy B. Welch
- Late thrombosis of paclitaxel-eluting stents: Long-term incidence, clinical consequences, and risk factors in a cohort of 604 patients
- Xacobe Flores-Ríos, Raquel Marzoa-Rivas, Juan Pablo Abugattás-de Torres, Pablo Piñón-Esteban, Guillermo Aldama-López, Jorge Salgado-Fernández, Ramón Calviño-Santos, José Manuel Vázquez-Rodríguez, Nicolás Vázquez-González, Alfonso Castro-Beiras
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