Chirag Bavishi1, Usman Baber2, Sadik Panwar2, Stefania Pirrotta1, George D Dangas2, Pedro Moreno3, Jacqueline Tamis-Holland1, Annapoorna S Kini2, Samin K Sharma4. 1. Department of Cardiology, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, United States. 2. Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, United States. 3. Department of Cardiology, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, United States; Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, United States. 4. Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, United States. Electronic address: samin.sharma@mountsinai.org.
Abstract
INTRODUCTION: Patients with diabetes and coronary artery disease remain at high risk for adverse cardiovascular events after percutaneous coronary intervention. The efficacy and safety of the various drug-eluting stents (DES) in patients with diabetes is unclear. METHODS: Randomized controlled trials comparing first-generation DES [paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES)] with everolimus-eluting stents (EES) and zotarolimus-eluting stents (ZES) in diabetic patients were systematically searched. Efficacy [target vessel revascularization (TVR) and target lesion revascularization (TLR)] and safety [major adverse cardiac events (MACE), all-cause and cardiac mortality, myocardial infarction, stent thrombosis] outcomes were evaluated. RESULTS: Eighteen randomized controlled trials comprising of 8095 patients (17,000 patient-years of follow-up) were included. Compared to first-generation DES, EES significantly decreased MACE by 18% (relative risk [RR]: 0.82, 95% confidence interval [CI]: 0.70-0.96), myocardial infarction by 43% (RR: 0.57, 95% CI: 0.39-0.84) and stent thrombosis by 46% (RR: 0.54, 95% CI: 0.35-0.82) in patients with diabetes. Moreover EES showed a trend towards reduction in rates of TLR and TVR (p=0.05). ZES was associated with 89% increased risk for TLR (RR: 1.89, 95% CI: 1.10-3.22) compared to first-generation DES. Furthermore, meta-regression analysis showed a greater magnitude of benefit of EES over first-generation DES for MACE (p=0.037) and stent thrombosis (p=0.036) in diabetic patients requiring Insulin. CONCLUSIONS: In patients with diabetes and coronary artery disease undergoing stenting, EES is the most efficacious and safe DES. The outcomes data for ZES in diabetes patients were limited and further trials are needed.
INTRODUCTION:Patients with diabetes and coronary artery disease remain at high risk for adverse cardiovascular events after percutaneous coronary intervention. The efficacy and safety of the various drug-eluting stents (DES) in patients with diabetes is unclear. METHODS: Randomized controlled trials comparing first-generation DES [paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES)] with everolimus-eluting stents (EES) and zotarolimus-eluting stents (ZES) in diabeticpatients were systematically searched. Efficacy [target vessel revascularization (TVR) and target lesion revascularization (TLR)] and safety [major adverse cardiac events (MACE), all-cause and cardiac mortality, myocardial infarction, stent thrombosis] outcomes were evaluated. RESULTS: Eighteen randomized controlled trials comprising of 8095 patients (17,000 patient-years of follow-up) were included. Compared to first-generation DES, EES significantly decreased MACE by 18% (relative risk [RR]: 0.82, 95% confidence interval [CI]: 0.70-0.96), myocardial infarction by 43% (RR: 0.57, 95% CI: 0.39-0.84) and stent thrombosis by 46% (RR: 0.54, 95% CI: 0.35-0.82) in patients with diabetes. Moreover EES showed a trend towards reduction in rates of TLR and TVR (p=0.05). ZES was associated with 89% increased risk for TLR (RR: 1.89, 95% CI: 1.10-3.22) compared to first-generation DES. Furthermore, meta-regression analysis showed a greater magnitude of benefit of EES over first-generation DES for MACE (p=0.037) and stent thrombosis (p=0.036) in diabeticpatients requiring Insulin. CONCLUSIONS: In patients with diabetes and coronary artery disease undergoing stenting, EES is the most efficacious and safe DES. The outcomes data for ZES in diabetespatients were limited and further trials are needed.
Authors: Aurelio Perez-Favila; Margarita L Martinez-Fierro; Jessica G Rodriguez-Lazalde; Miguel A Cid-Baez; Michelle de J Zamudio-Osuna; Ma Del Rosario Martinez-Blanco; Fabiana E Mollinedo-Montaño; Iram P Rodriguez-Sanchez; Rodrigo Castañeda-Miranda; Idalia Garza-Veloz Journal: Medicina (Kaunas) Date: 2019-10-25 Impact factor: 2.430
Authors: Juan F Iglesias; Dik Heg; Marco Roffi; David Tüller; Jonas Lanz; Fabio Rigamonti; Olivier Muller; Igal Moarof; Stéphane Cook; Daniel Weilenmann; Christoph Kaiser; Florim Cuculi; Marco Valgimigli; Peter Jüni; Stephan Windecker; Thomas Pilgrim Journal: J Am Heart Assoc Date: 2019-11-07 Impact factor: 5.501