Drug-eluting stents better, safer than bare metal in diabetics

Any drug-eluting stent was safer and more efficacious than bare metal stents in diabetics, with the everolimus-eluting stent appearing to have the best results, a meta-analysis found.

Researchers conducted a meta-analysis of 42 randomized clinical trials involving 10,714 patients with 22,844 patient-years of follow-up. Four drug-eluting stents (sirolimus, paclitaxel, everolimus and zotarolimus) were compared on rates of target vessel revascularization and safety endpoints of death, myocardial infarction or stent thrombosis.

Results were published online Aug. 10 by BMJ.

All drug-eluting stents were associated with a reduction in target vessel revascularization, ranging from 37% to 69%. Everolimus-eluting stents performed about the same as sirolimus-eluting stents. These two stents had lower rates than paclitaxel-eluting stents or zotarolimus-eluting stents, and all four did better than bare metal stents.

There was about an 87% probability that everolimus-eluting stents were the most efficacious, the authors reported. The median target vessel revascularization rate with bare metal stents was 109.40 per 1,000 patient-years of follow-up, and the rate with the everolimus-eluting stent was 34.55 per 1,000 patient-years.

There was no increased risk of any safety outcome, including very late stent thrombosis, with any drug-eluting stents compared with bare metal stents, the researchers reported. There was about a 62% probability that the everolimus-eluting stent was the safest stent on the outcome of stent thrombosis, a 57% probability that everolimus-eluting stents were associated with the lowest death rate, and an 81% probability that everolimus-eluting stents had the lowest rate of myocardial infarction.

“In patients with diabetes all drug eluting stents are highly efficacious at reducing the risk of target vessel revascularization without increases in any adverse safety outcomes, including very late stent thrombosis, when compared with bare metal stents,” the authors concluded. “There were significant differences among types of drug eluting stent for efficacy and safety, such that everolimus eluting stents were the most efficacious and safe.”