The effect of drug-eluting stents on intermediate angiographic and clinical outcomes in diabetic patients: Insights from randomized clinical trials

Dharam J. Kumbhani, Anthony A. Bavry, Apur R. Kamdar, Thomas J. Helton, Deepak L. Bhatt

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)640-647
Number of pages8
JournalAmerican Heart Journal
Volume155
Issue number4
DOIs
StatePublished - Apr 2008

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Drug-Eluting Stents
Randomized Controlled Trials
Stents
Odds Ratio
Metals
Myocardial Infarction
Thrombosis
Incidence
Sirolimus
Paclitaxel
Meta-Analysis
Safety
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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The effect of drug-eluting stents on intermediate angiographic and clinical outcomes in diabetic patients : Insights from randomized clinical trials. / Kumbhani, Dharam J.; Bavry, Anthony A.; Kamdar, Apur R.; Helton, Thomas J.; Bhatt, Deepak L.

In: American Heart Journal, Vol. 155, No. 4, 04.2008, p. 640-647.

Research output: Contribution to journalArticle

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abstract = "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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