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Diabetics do better with sirolimus-eluting stents

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In diabetic patients, sirolimus-eluting stents reduce the risk for coronary artery restenosis compared with paclitaxel-eluting stents, a meta-analysis shows.

Because the relative efficacy and safety of these two drug-eluting stents for diabetics remains controversial, senior investigator Dr. Junbo Ge and colleagues at Fudan University, Shanghai, China, searched PubMed, EMBASE and the Cochrane Central Register of Controlled Trials to identify relevant articles.

As reported online November 14 in the American Journal of Cardiology, their meta-analysis included 5 randomized controlled trials (7 reports) involving 1173 patients with diabetes and coronary artery disease (CAD) randomly assigned to receive sirolimus- (n = 594) or paclitaxel-eluting stents (n = 579). Follow-up ranged from 6 to 24 months. Analysis was by intention-to-treat.

Thirty sirolimus-treated patients (5.1%) and 66 paclitaxel-treated patients (11.4%) required target lesion revascularization (pooled OR 0.41, p < 0.001). Also, sirolimus was significantly more effective in reducing the incidence of 50% restenosis: 5.6% vs 16.4% (pooled OR 0.30, p < 0.001). By contrast, there was no significant difference between groups in the number of cases of stent thrombosis, cardiac death, or myocardial infarction. “Previous meta-analyses have shown that patients receiving sirolimus-eluting stents had a significantly lower risk for restenosis and/or target lesion revascularization compared to those receiving paclitaxel-eluting stents in a broad population,” the researchers said. They conclude, “Our results demonstrate that such benefits of sirolimus-eluting stents can be extrapolated to patients with diabetes.” Reference:
Am J Cardiol 2010.