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Patients with diabetes likely to benefit most from everolimus-eluting stents
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New data showed that all available drug-eluting stents were safe and effective in reducing the risk for target vessel revascularization and target lesion revascularization in patients with diabetes. However, results also suggested that everolimus-eluting stents may be the best option for this patient population.
To compare the efficacy and safety of drug-eluting stents with both bare metal stents and each other, Sripal Bangalore, MD, assistant professor at New York University School of Medicine, and colleagues conducted a mixed treatment comparison meta-analysis of 42 randomized controlled trials involving 10,714 patients with 22,844 patient-years of follow-up.
“When compared with bare metal stents, all drug eluting-stents were associated with a 37% to 69% reduction in the rate of target vessel revascularization, but the magnitude of this reduction varied with the type of stent,” researchers wrote.
In terms of efficacy, researchers found a 62% probability that everolimus-eluting stents (Xience V, Abbott Vascular) have the lowest rate of any stent thrombosis and an 87% probability that everolimus-eluting stents have the lowest rate of target vessel revascularization when compared with sirolimus- (Cypher, Cordis), paclitaxel- (Taxus Express, Boston Scientific) and zotarolimus-eluting stents (Resolute, Medtronic). Sirolimus-eluting stents were also found to be similar to paclitaxel- and everolimus-eluting stents but significantly more effective than zotarolimus-eluting stents. Data also indicated that everolimus-eluting stents were more efficacious than paclitaxel- or zotarolimus-eluting stents.
In terms of safety, everolimus-eluting stents were associated with a 57% probability of having the lowest death rate and an 81% probability of having the lowest rate of myocardial infarction. Researchers also found a median death rate of 17.51 per 1,000 patient-years of follow-up among patients with bare metal stents. For drug-eluting stents, median death rate varied between 14.51 and 20.27 per 1,000 patient-years, according to data.
The researchers said there was limited usable data on the use of zotarolimus-eluting stents in patients with diabetes, which may have affected their findings.
Disclosure: Dr. Bangalore is on the advisory boards of Boehringer Ingelheim and Daiichi Sankyo. Dr. Cutlip was principal investigator on the Medtronic EDUCATE trial. All other researchers report no relevant financial disclosures.
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