Abstract 2147: Drug-Eluting Stents Versus Bare Metal Stents in Diabetic Patients With Acute Myocardial Infarction: A Pooled Patient-Level Analysis of 7 Randomized Trials.
Background: There have been concerns about the use of drug-eluting stents (DES) in diabetic patients with coronary artery disease without acute myocardial infarction (AMI). A recent pooled analysis confined to the subgroup of 428 diabetic patients from 4 randomized trials ( N Engl J Med 2007;356:989–97) showed an increased risk of death in the sirolimus-eluting stent group (23 death cases) as compared to the bare-metal stent (BMS) group (10 death cases). It is not known whether diabetic patients with AMI benefit from the use of DES.
Methods: We performed an analysis of individual data on 2476 patients with AMI enrolled in 7 randomized trials comparing DES (sirolimus- or paclitaxel-eluting stents) with BMS (mean follow-up interval: 12 to 24 months). The trials included were: BASKET-AMI, the trial of Di Lorenzo et al, HAAMU-STENT, PASSION, SESAMI, STRATEGY and TYPHOON. Diabetes mellitus was present in 389 patients (15.7%), who were the subject of this analysis. The outcomes of interest were: stent thrombosis, the composite of death or recurrent MI, and target lesion revascularization (TLR).
Results: There were 206 diabetic patients allocated to the DES group (127 patients with sirolimus-eluting stent and 79 patients with paclitaxel-eluting stent) and 183 diabetic patients to BMS group. The number of events in each group is shown in the Table⇓ along with the hazard ratios associated with the use of DES.
Conclusion: In diabetes patients with AMI, the use of DES significantly reduces the risk of reintervention (TLR) without any significant impact on death or recurrent MI compared with BMS. The trend toward a lower risk of stent thrombosis with DES needs to be confirmed in larger studies with longer follow-up.