Drug eluting and bare metal stents in people with and without diabetes: collaborative network meta-analysis.
OBJECTIVE
To compare the effectiveness and safety of three types of stents (sirolimus eluting, paclitaxel eluting, and bare metal) in people with and without diabetes mellitus.


METHODS
Collaborative network meta-analysis.


METHODS
Electronic databases (Medline, Embase, the Cochrane Central Register of Controlled Trials), relevant websites, reference lists, conference abstracts, reviews, book chapters, and proceedings of advisory panels for the US Food and Drug Administration. Manufacturers and trialists provided additional data.


METHODS
Network meta-analysis with a mixed treatment comparison method to combine direct within trial comparisons between stents with indirect evidence from other trials while maintaining randomisation. Overall mortality was the primary safety end point, target lesion revascularisation the effectiveness end point.


RESULTS
35 trials in 3852 people with diabetes and 10,947 people without diabetes contributed to the analyses. Inconsistency of the network was substantial for overall mortality in people with diabetes and seemed to be related to the duration of dual antiplatelet therapy (P value for interaction 0.02). Restricting the analysis to trials with a duration of dual antiplatelet therapy of six months or more, inconsistency was reduced considerably and hazard ratios for overall mortality were near one for all comparisons in people with diabetes: sirolimus eluting stents compared with bare metal stents 0.88 (95% credibility interval 0.55 to 1.30), paclitaxel eluting stents compared with bare metal stents 0.91 (0.60 to 1.38), and sirolimus eluting stents compared with paclitaxel eluting stents 0.95 (0.63 to 1.43). In people without diabetes, hazard ratios were unaffected by the restriction. Both drug eluting stents were associated with a decrease in revascularisation rates compared with bare metal stents in people both with and without diabetes.


CONCLUSIONS
In trials that specified a duration of dual antiplatelet therapy of six months or more after stent implantation, drug eluting stents seemed safe and effective in people both with and without diabetes.
Stettler
Christoph
C
Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland.
Allemann
Sabin
S
Wandel
Simon
S
Kastrati
Adnan
A
Morice
Marie Claude
MC
Schömig
Albert
A
Pfisterer
Matthias E
ME
Stone
Gregg W
GW
Leon
Martin B
MB
de Lezo
José Suárez
JS
Goy
Jean-Jacques
JJ
Park
Seung-Jung
SJ
Sabaté
Manel
M
Suttorp
Maarten J
MJ
Kelbaek
Henning
H
Spaulding
Christian
C
Menichelli
Maurizio
M
Vermeersch
Paul
P
Dirksen
Maurits T
MT
Cervinka
Pavel
P
De Carlo
Marco
M
Erglis
Andrejs
A
Chechi
Tania
T
Ortolani
Paolo
P
Schalij
Martin J
MJ
Diem
Peter
P
Meier
Bernhard
B
Windecker
Stephan
S
Jüni
Peter
P