Meta-Analysis of Randomized Trials of Drug-Eluting Stents Versus Bare Metal Stents in Patients With Diabetes Mellitus

Thomas F. Boyden, Brahmajee K. Nallamothu, Mauro Moscucci, Paul S. Chan, P. Michael Grossman, Thomas T. Tsai, Stanley J. Chetcuti, Eric R. Bates, Hitinder S. Gurm

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Abstract

Diabetes mellitus is a major risk factor for restenosis in patients undergoing percutaneous coronary intervention. Randomized controlled trials comparing drug-eluting stents (DESs) with bare metal stents (BMSs) showed a marked decrease in in-stent restenosis and target lesion revascularization with DESs in the total patient population enrolled in the studies, including patients with diabetes. However, it remains unclear whether the antirestenotic benefit of DESs is preserved in the high-risk diabetic subgroup. MEDLINE, EMBASE, ISI Web of Knowledge, Current Contents, International Pharmaceutical Abstracts, and recent Scientific Sessions databases were searched to identify relevant clinical trials comparing DESs with BMSs. A randomized controlled trial was included if it provided outcome data for patients with diabetes for ≥1 of the following: late lumen loss, in-stent restenosis, or target lesion revascularization. Data were combined using fixed-effects models, and standard tests for heterogeneity were performed. Eight studies with 1,520 patients with diabetes were identified that reported ≥1 outcome of interest. Mean late lumen losses (7 studies) were 0.93 mm (95% confidence interval [CI] 0.510 to 1.348) with BMSs and 0.18 mm (95% CI -0.088 to +0.446) with DESs. For patients receiving a DES, this translated into a marked decrease in in-stent restenosis (7 studies, RR 0.14, 95% CI 0.10 to 0.22, p <0.001) and target lesion revascularization (8 studies, RR 0.34, 95% CI 0.26 to 0.45, p <0.001). DES use is associated with a marked decrease in in-stent restenosis and target lesion revascularization in patients with diabetes. In conclusion, the analysis supports the current widespread use of DESs in these high-risk patients.

Original languageEnglish
Pages (from-to)1399-1402
Number of pages4
JournalAmerican Journal of Cardiology
Volume99
Issue number10
DOIs
StatePublished - May 15 2007

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Drug-Eluting Stents
Stents
Meta-Analysis
Diabetes Mellitus
Metals
Confidence Intervals
Randomized Controlled Trials
Percutaneous Coronary Intervention
Type 1 Diabetes Mellitus
MEDLINE
Clinical Trials
Databases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Boyden, T. F., Nallamothu, B. K., Moscucci, M., Chan, P. S., Grossman, P. M., Tsai, T. T., ... Gurm, H. S. (2007). Meta-Analysis of Randomized Trials of Drug-Eluting Stents Versus Bare Metal Stents in Patients With Diabetes Mellitus. American Journal of Cardiology, 99(10), 1399-1402. https://doi.org/10.1016/j.amjcard.2006.12.069

Meta-Analysis of Randomized Trials of Drug-Eluting Stents Versus Bare Metal Stents in Patients With Diabetes Mellitus. / Boyden, Thomas F.; Nallamothu, Brahmajee K.; Moscucci, Mauro; Chan, Paul S.; Grossman, P. Michael; Tsai, Thomas T.; Chetcuti, Stanley J.; Bates, Eric R.; Gurm, Hitinder S.

In: American Journal of Cardiology, Vol. 99, No. 10, 15.05.2007, p. 1399-1402.

Research output: Contribution to journalArticle

Boyden, TF, Nallamothu, BK, Moscucci, M, Chan, PS, Grossman, PM, Tsai, TT, Chetcuti, SJ, Bates, ER & Gurm, HS 2007, 'Meta-Analysis of Randomized Trials of Drug-Eluting Stents Versus Bare Metal Stents in Patients With Diabetes Mellitus', American Journal of Cardiology, vol. 99, no. 10, pp. 1399-1402. https://doi.org/10.1016/j.amjcard.2006.12.069
Boyden, Thomas F. ; Nallamothu, Brahmajee K. ; Moscucci, Mauro ; Chan, Paul S. ; Grossman, P. Michael ; Tsai, Thomas T. ; Chetcuti, Stanley J. ; Bates, Eric R. ; Gurm, Hitinder S. / Meta-Analysis of Randomized Trials of Drug-Eluting Stents Versus Bare Metal Stents in Patients With Diabetes Mellitus. In: American Journal of Cardiology. 2007 ; Vol. 99, No. 10. pp. 1399-1402.
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abstract = "Diabetes mellitus is a major risk factor for restenosis in patients undergoing percutaneous coronary intervention. Randomized controlled trials comparing drug-eluting stents (DESs) with bare metal stents (BMSs) showed a marked decrease in in-stent restenosis and target lesion revascularization with DESs in the total patient population enrolled in the studies, including patients with diabetes. However, it remains unclear whether the antirestenotic benefit of DESs is preserved in the high-risk diabetic subgroup. MEDLINE, EMBASE, ISI Web of Knowledge, Current Contents, International Pharmaceutical Abstracts, and recent Scientific Sessions databases were searched to identify relevant clinical trials comparing DESs with BMSs. A randomized controlled trial was included if it provided outcome data for patients with diabetes for ≥1 of the following: late lumen loss, in-stent restenosis, or target lesion revascularization. Data were combined using fixed-effects models, and standard tests for heterogeneity were performed. Eight studies with 1,520 patients with diabetes were identified that reported ≥1 outcome of interest. Mean late lumen losses (7 studies) were 0.93 mm (95{\%} confidence interval [CI] 0.510 to 1.348) with BMSs and 0.18 mm (95{\%} CI -0.088 to +0.446) with DESs. For patients receiving a DES, this translated into a marked decrease in in-stent restenosis (7 studies, RR 0.14, 95{\%} CI 0.10 to 0.22, p <0.001) and target lesion revascularization (8 studies, RR 0.34, 95{\%} CI 0.26 to 0.45, p <0.001). DES use is associated with a marked decrease in in-stent restenosis and target lesion revascularization in patients with diabetes. In conclusion, the analysis supports the current widespread use of DESs in these high-risk patients.",
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