BMJ: DES reduces revascularization rates in patients with or without diabetes
In trials that specified a duration of dual-antiplatelet therapy of six months or more after stent implantation, drug-eluting stents (DES) seemed safe and effective in people both with and without diabetes, according to a meta-analysis published Aug. 31 online in the British Medical Journal.

Christoph Stettler, MD, senior research fellow from the University Hospital in Bern, Switzerland, and colleagues undertook the study o compare the effectiveness and safety of three types of DES (sirolimus-eluting, paclitaxel-eluting and bare-metal stents) in people with and without diabetes mellitus.

The researchers conducted a 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 randomization.

Overall mortality was the primary safety end point, target lesion revascularization the effectiveness end point, according to the investigators.

The authors wrote that 35 trials in 3,852 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, according to the researchers.

Stettler and colleagues found that 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; paclitaxel-eluting stents compared with bare metal stents 0.91; and sirolimus-eluting stents compared with paclitaxel-eluting stents 0.95.

In people without diabetes, the authors wrote that hazard ratios were unaffected by the restriction.

The researchers concluded that both DES were associated with a decrease in revascularization rates, compared with bare metal stents in people both with and without diabetes.

Stettler and colleagues wrote that “compared with bare metal stents, target lesion revascularization rates are strongly decreased by use of sirolimus and paclitaxel drug eluting stents in people with and without diabetes.”