title: A meta-analysis of specifically designed randomized trials of sirolimus-eluting versus paclitaxel-eluting stents in diabetic patients with coronary artery disease.
abstract: BACKGROUND
  There is an ongoing debate on the optimal drug-eluting stent (DES) in diabetic patients with coronary artery disease. We addressed this issue by making a synthesis of the available evidence on the relative long-term efficacy and safety of sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) in these patients.
  
  
  METHODS
  Individual patient data were analyzed from 6 randomized trials specifically designed to compare SES with PES in diabetic patients. In total, 1183 patients were followed up for a median of 3.9 years (25th, 75th percentiles 3.4-4.5 years). The primary efficacy end point was target lesion revascularization (TLR). The composite of death and myocardial infarction (MI) was the primary safety end point. Stent thrombosis was a secondary end point. Overall hazard ratios (HRs) with 95% CIs were calculated as summary estimates.
  
  
  RESULTS
  No significant heterogeneity was seen across the 6 randomized trials for all analyzed events. Sirolimus-eluting stent was associated with a significant reduction in the risk of TLR (HR 0.65 [0.47-0.91], P = .01). No significant differences were observed regarding the risk of death or MI (HR 1.04 [0.74-1.45], P = .83) and stent thrombosis (HR 1.00 [0.31-3.30], P = .67). Mortality was also not affected by the type of DES (HR 0.95 [0.65-1.39], P = .79).
  
  
  CONCLUSIONS
  In diabetic patients with coronary artery disease, SES leads to a sustained reduction in the risk of TLR compared with PES. Both these DES types are, however, comparable with respect to the risk of stent thrombosis, MI, or death over long-term follow-up.
authors: Deutsches Herzzentrum, Technische Universität, Munich, Germany. Kufners@dhm.mhn.de
authors: Sebastian
authors: S
authors: Kufner
authors: Antoinette
authors: A
authors: de Waha
authors: Fabrizio
authors: F
authors: Tomai
authors: Seong-Wook
authors: SW
authors: Park
authors: Seung-Whan
authors: SW
authors: Lee
authors: Do-Sun
authors: DS
authors: Lim
authors: Moo Hyun
authors: MH
authors: Kim
authors: Anders M
authors: AM
authors: Galloe
authors: Michael
authors: M
authors: Maeng
authors: Carlo
authors: C
authors: Briguori
authors: Alban
authors: A
authors: Dibra
authors: Albert
authors: A
authors: Schömig
authors: Adnan
authors: A
authors: Kastrati
mesh_terms: D003324:Coronary Artery Disease / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000188:drug therapy*; D054855:Drug-Eluting Stents; D006801:Humans; D017239:Paclitaxel / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D020123:Sirolimus / Q000008:administration & dosage*
chemical_list: D017239:Paclitaxel; D020123:Sirolimus