De Luca, Giuseppe2; Dirksen, Maurits T2; Spaulding, Christian2; Kelbæk, Henning Skov3; Schalij, Martin2; Thuesen, Leif4; van der Hoeven, Bas2; Vink, Marteen A2; Kaiser, Christopher2; Musto, Carmine2; Chechi, Tania2; Spaziani, Gaia2; Diaz de la Llera, Luis Salvador2; Pasceri, Vincenzo2; Di Lorenzo, Emilio2; Violini, Roberto2; Suryapranata, Harry2; Stone, Gregg W2
1 Department of Clinical Medicine - The Department of Cardiological Medicine B, Department of Clinical Medicine, Health, Aarhus University2 unknown3 Institut for Klinisk Medicin4 The Department of Cardiological Medicine B, Faculty of Health Sciences, Aarhus University, Aarhus University
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 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.
American Journal of Cardiology, 2013, Vol 111, Issue 9, p. 1295-304