Long-term outcome after sirolimus-eluting stents versus bare metal stents in patients with Diabetes mellitus: a patient-level meta-analysis of randomized trials
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Antoinette de Waha Alban Dibra Sebastian Kufner Dietrich Baumgart Manel Sabate Aleardo Maresta Albert Scho¨mig Adnan Kastrati
- چاپ و سال / کشور: 2011
Description
Background Although it is widely believed that patients with diabetes mellitus obtain the greatest benefit from drug-eluting stents, convincing evidence on long-term efficacy and safety of these stents is lacking. Methods We performed a meta-analysis of individual patient data from four randomized trials including 583 patients comparing sirolimus eluting with bare metal stents (median follow-up of 4.2 years). These were the only specific trials reporting on drug-eluting stents in diabetic patients. The primary endpoint was the incidence of major cardiac events. The secondary endpoints were all-cause mortality and myocardial infarction as a safety endpoint and target lesion re-intervention as an efficacy endpoint. Stent thrombosis was also evaluated. Results There was a significant reduction in the overall hazard of major cardiac events (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.36–0.63, P\0.001) with sirolimus- eluting stents. This was mostly due to a significant reduction in the overall hazard of repeat revascularization (HR 0.27, 95% CI 0.18–0.41, P\0.001) in favor of sirolimus- eluting stents. However, the overall hazard of death (HR 0.91, 95% CI 0.59–1.41, P = 0.68) as well as death or myocardial infarction (HR 0.77, 95% CI 0.54–1.09, P = 0.14) were not significantly different between the groups. No significant differences were observed regarding stent thrombosis (HR 0.50, 95% CI 0.15–1.69, P = 0.26). Conclusions Sirolimus-eluting stents are highly effective in reducing the risk for major cardiac events and safe in diabetic patients with coronary artery disease.
Clin Res Cardiol (2011) 100:561–570 DOI 10.1007/s00392-010-0278-8 Received: 8 October 2010 / Accepted: 23 December 2010 / Published online: 8 January 2011
