title: Meta-analysis comparing efficacy and safety of first generation drug-eluting stents to bare-metal stents in patients with diabetes mellitus undergoing primary percutaneous coronary intervention.
abstract: Several concerns have emerged regarding the higher risk for stent thrombosis (ST) after drug-eluting stent (DES) implantation, especially in the setting of ST-segment elevation myocardial infarction (STEMI). Few data have been reported so far in patients with diabetes mellitus, which is associated with high rates of target vessel revascularization after bare-metal stent (BMS) implantation but also higher rates of ST after DES implantation. Therefore, the aim of this study was to perform a meta-analysis of individual patients' data to evaluate the long-term safety and effectiveness of DES compared with BMS in patients with diabetes who undergo primary percutaneous coronary intervention for STEMI. Published reports were scanned by formal searches of electronic databases (MEDLINE and CENTRAL). All completed randomized trials of DES for STEMI were examined. No language restrictions were enforced. Individual patients' data were obtained from 11 of 13 trials, including a total of 972 patients with diabetes (616 [63.4%] randomized to DES and 356 [36.6%] to BMS). At long-term follow-up (median 1,095 days, interquartile range 1,087 to 1,460), DES significantly reduced the occurrence of target vessel revascularization (hazard ratio 0.42, 95% confidence interval 0.29 to 0.59, p <0.0001), without any significant difference in terms of mortality, late reinfarction, and ST (>1 year) with DES. In conclusion, this meta-analysis, based on individual patients' data from 11 randomized trials, showed that among patients with diabetes with STEMIs who undergo primary percutaneous coronary intervention, sirolimus-eluting stents and paclitaxel-eluting stents, compared with BMS, are associated with a significant reduction in target vessel revascularization at long-term follow-up, without any apparent concern in terms of mortality, despite the trend toward higher rates of reinfarction and ST.
authors.affiliation: Division of Cardiology, Ospedale Maggiore Della Carità, Eastern Piedmont University, Novara, Italy. g.d.deluca@isala.nl
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Luca
authors.forename: Maurits T
authors.initials: MT
authors.lastname: Dirksen
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.forename: Martin
authors.initials: M
authors.lastname: Schalij
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.forename: Bas
authors.initials: B
authors.lastname: van der Hoeven
authors.forename: Marteen A
authors.initials: MA
authors.lastname: Vink
authors.forename: Christopher
authors.initials: C
authors.lastname: Kaiser
authors.forename: Carmine
authors.initials: C
authors.lastname: Musto
authors.forename: Tania
authors.initials: T
authors.lastname: Chechi
authors.forename: Gaia
authors.initials: G
authors.lastname: Spaziani
authors.forename: Luis Salvador
authors.initials: LS
authors.lastname: Diaz de la Llera
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pasceri
authors.forename: Emilio
authors.initials: E
authors.lastname: Di Lorenzo
authors.forename: Roberto
authors.initials: R
authors.lastname: Violini
authors.forename: Harry
authors.initials: H
authors.lastname: Suryapranata
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D003920:Diabetes Mellitus / Q000401:mortality*; D054855:Drug-Eluting Stents; D014943:Global Health; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011474:Prosthesis Design; D015996:Survival Rate