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Efficacy of Drug-Eluting Stents Confirmed in Diabetic Patients
May 18, 2007
by Josh Murphy Results from a meta-analysis of randomized controlled trials corroborate the efficacy of drug-eluting compared to bare metal stents in diabetic patients with coronary artery disease, according to Dr. Thomas Boyden and colleagues with the University of Michigan (USA)1.
These investigators pooled results from trials (N=8) that randomized patients with diabetes and coronary artery disease to sirolimus (Sirius® , Cordis)- or paclitaxel (TAXUS®, Boston Scientific)-eluting stents or bare metal stents and reported late lumen loss, in-stent restenosis, or target lesion revascularization data on diabetic patients.
There were 1,520 diabetic patients included in this analysis. Rates of in-stent restenosis were reduced by a significant 86% in diabetic patients randomized to drug-eluting stents compared to bare metal (RR 0.14, 95% CI 0.1-0.22, P<0.001) (Figure 1). Target lesion revascularization was also significantly reduced by 66% in the drug-eluting stent group (7.5 vs 22.9%; RR 0.34, 95% CI 0.26-0.45, P<0.001) (Figure 2).
There were 4 trials that provided outcomes data stratified by insulin dependence. In each trial, rates of target lesion revascularization (Figure 3) and late lumen loss (Figure 4) were consistently lower in insulin-dependent and non-insulin dependent patients randomized to drug-eluting stents.
While these results do indicate greater efficacy of drug-eluting stents in diabetic patients, they are limited by the lack of direct head-to-head treatment data in diabetic patients, investigators note. Furthermore, since follow-up only ranged from 6-9 months long-term efficacy cannot be elucidated.
Reference
- Boyden TF, Nallamothu BK, Moscucci M, et al. Meta-Analysis of Randomized Trials of Drug-Eluting Stents Versus Bare Metal Stents in Patients With Diabetes Mellitus. Am J Cardiol 2007;99:1399-1402.
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