Drug-eluting stents cleared for diabetes patients

By Piriya Mahendra, MedWire News Reporter

All currently available drug-eluting stents (DES) are more effective than bare metal stents (BMS) for patients with diabetes, research suggests.

However, of the DES, everolimus-eluting stents are the most efficacious and safe, report Sripal Bangalore (New York University, USA) and colleagues in the British Medical Journal.

In a meta-analysis of 42 trials comprising 22,844 patient-years of follow-up, all currently used DES were associated with significant reductions in target vessel revascularization, ranging from 37% to 69%, compared with BMS.

However, the efficacy of DES varied with the type of stent used. Indeed, there was an 87% probability that everolimus-eluting stents were more efficacious than the other stents analyzed, which included sirolimus-eluting stents, paclitaxel-eluting stents, and zotarolimus-eluting stents.

Moreover, the median target vessel revascularization rate with BMS was 109.40 per 1000 patient-years of follow-up, compared with a rate of 34.55 per 1000 patient-years with everolimus-eluting stents.

Compared with BMS, there was no significant increase in death with any of the DES. However, there was a 57% probability that everolimus-eluting stents were associated with the lowest death rate (14.51 vs 17.51 per 1000 patient-years in BMS).

There was also a 62% probability that everolimus-eluting stents had the lowest rate of any stent thrombosis (0.82 vs 1.49 per 1000 patient-years).

Bangalore and co-authors point out that data on the zotarolimus-eluting stent was limited and more data is therefore needed before any conclusions can be drawn on its efficacy and safety.

"The long-term efficacy and safety of various DES compared against each other and compared with BMS in patients with diabetes is controversial, with various reports of superiority of paclitaxel-eluting stents, sirolimus-eluting stents, or everolimus-eluting stents," explain the authors.

However, "we found considerable differences in the relative efficacy and safety of currently used DES, such that everolimus eluting stents were the safest and most efficacious," conclude Bangalore and team.

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